Table 2.
Summary of literature
| Practice | Summary of the Literature | |
|---|---|---|
| Supporting the practice | Refuting the practice | |
| Blade Change | Bacteria are retained in hair follicles and sweat glands | Cultured superficial blades are not correlated to infections; a randomized study of one- and two-blade surgeries did not show an increase in infections |
| Bending the knee with tourniquet | None found | An experimental study showed quad binding does not occur |
| DVT and bed rest | None found | Several large clinical studies showed early mobilization to be safe, and a randomized prospective trial showed it to promote earlier resolution of leg pain and swelling without an increase of complications |
| Antibiotics in irrigation | In vitro and several animal studies support the effectiveness of antibiotics in irrigation; some studies from general surgery support its use in body cavities | In vitro studies using bone or metal surfaces failed to show antibiotics’ superiority in removing bacteria. A randomized prospective study compared soap with bacitracin irrigation in human orthopaedic surgery and found no difference in infections but higher wound complications with bacitracin. |
| Hip precautions | Higher rates of dislocation associated with poor compliance or neuromuscular conditions in many series; biomechanical simulation models predict dislocations with high-risk maneuvers. | Prospective study showed low rate of dislocations when no hip precautions were used with an anterolateral approach to the hip |
| Antibiotics for wound drainage | In vitro and animal studies suggest that suction drains represent an entryway for bacteria and antibiotics may reduce infections. Some clinical studies in gynecologic and general surgery patients support this. | No study evaluated this issue directly, but one study found that extending antibiotics from 8 hours to 16 hours did not make a difference in infections despite the use of drains. Penetration of antibiotic into the hematoma may be insufficient. |
| Hardware removal in pediatrics | Several case reports of fractures associated with implants and case reports of malignancies associated with implants. Long-term risk of infection associated with implants. | Series reporting high rate of refracture after hardware removal; series with high rates of wound infection after hardware removal; risk of malignancy not detected in large clinical studies; no proven cases of ion hypersensitivity |
| Operative time and infection | Several studies in general surgery, and one retrospective study in orthopaedic surgery showed a correlation of operative time and infection | Numerous prospective and retrospective studies failed to detect an increase in infection with operative time in orthopaedic surgery |
| Avoiding dressing changes | Multiple studies show hands to be a leading source of contamination | One study showed higher rates of hand contamination in healthcare workers not involved in patient care; multiple studies showed hand-washing and surgical scrubbing to be effective in decontaminating the hands of surgeons |
DVT = deep venous thrombosis.