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Prevention of Perioperative Infection
Nicholas Fletcher, MD1; D'Mitri Sofianos, BS1; Marschall Brantling Berkes, BS1; William T. Obremskey, MD, MPH1
1 Vanderbilt Orthopedic Trauma, Medical Center East–South Tower, Suite 4200, Nashville, TN 37232-8774. E-mail address for W.T. Obremskey: william.obremskey@vanderbilt.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Vanderbilt Orthopedic Trauma, Nashville, Tennessee

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jul 01;89(7):1605-1618. doi: 10.2106/JBJS.F.00901
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Administration of preoperative antibiotics is associated with reduced rates of surgical site infections. Antibiotics should be continued for no longer than twenty-four hours after elective surgery or surgical treatment of closed fractures. Chlorhexidine gluconate is superior to povidone-iodine for preoperative antisepsis for the patient and surgeon. Closed suction drainage is not warranted in elective total joint replacement. It is associated with an increased relative risk of transfusions. Drains left in situ for more than twenty-four hours are at an increased risk for bacterial contamination. The rate of postoperative infections associated with occlusive dressings is lower than that associated with nonocclusive dressings. Appropriate management of blood glucose levels, oxygenation, and the temperature of the patient reduces the risk of postoperative infection.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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