| 1. Please indicate the number of primary total hip and total knee replacement surgeries you performed in fiscal year 2004/05. | |||||||
| Total hip | __ < 25 | __ 25–50 | __ 50–100 | __ 100–200 | __ > 200 | ||
| Total knee | __ < 25 | __ 25–50 | __ 50–100 | __ 100–200 | __ > 200 | ||
| 2. Do you routinely use systemic antibiotic prophylaxis in total joint replacement (TJR) surgery? | __ Yes | __ No | |||||
| 3. Please indicate the antibiotic drug(s) you most commonly use per procedure and dosage (check all that apply). | |||||||
| __ vancomycin | __ 1 g | __ other | __ gentamicin | __ 80 mg | __ 240 g | ||
| __ cefazolin (Ancef) | __ 1 g | __ 2 g | __ tobramycin | __ 80 mg | __ 240 mg | ||
| __ cefuroxime | __ 750 mg | __ 1.5 g | __ other drug | __ other dosage | |||
| 4. Is the dosage of perioperative antibiotic given a standard dose or adjusted for weight (mg/kg)? | __ standard | __ mg/kg | |||||
| 5. At which point of care is the antibiotic administered? | |||||||
| __ same day surgery unit | __ patient receiving area | __ surgical suite | __ other | ||||
| 6. Please estimate mean timing for when the prophylactic agent is administered, relative to when the skin incision is made (e.g., 1 h prior to skin incision). | |||||||
| __ < 30 min | __ 30–60 min | __ 61–120 min | __ > 120 min | ||||
| 7. For cemented primary TJR, is antibiotic included in the cement? | __ Yes | __ No (if no, go to question #11) | |||||
| 8. Is the antibiotic included for all cemented cases or for high-risk cases only (i.e., diabetic)? | |||||||
| __ all cemented cases | __ high-risk cases only | ||||||
| 9. If you use prophylactic antibiotics in cemented cases, please indicate the antibiotic used. | |||||||
| __ surgeon-mixed, drug:__________ | dose/bag of cement:_____ | ||||||
| __ premixed commercially available product, specify:__________ | |||||||
| 10. Does your antibiotic prophylaxis regimen differ between total hip and total knee arthroplasty cases? | |||||||
| __ Yes | __ No | If yes, please explain:__________ | |||||
| 11. Postoperatively, how many doses are given and what is the usual duration of the prophylaxis? | |||||||
| Dose:__________ | Duration:_______________ | ||||||
| The following questions are specific to persistent serous wound drainage postoperativewithoutredness, warmth or fever. | |||||||
| 12. Do you ever culture serous drainage without the presence of redness, warmth or fever in the first week following surgery? | __ Yes | __ No | |||||
| 13. Do you ever assess wounds for fluid collections via an ultrasound? | __ Yes | __ No | |||||
| 14. If persistent serous wound drainage at or beyond postoperative day 4, do you take the patient back to the operating room? | __ Yes | __ No | |||||
| 15. Do you allow patients to go home with serous wound drainage? | __ Yes | __ No | |||||
| 16. Do you prescribe antibiotics if patient is discharged home with a draining wound? (if no, go to question #18) |
__ Always | __ Sometimes | __ No | ||||
| 17. If you prescribe antibiotics for patient discharged with a draining wound, please specify type and duration. | |||||||
| __ oral antibiotics | Duration:_______________ | ||||||
| __ IV antibiotics | Duration:_______________ | ||||||
| 18. Do you have a surgical site infection surveillance program at your hospital? (if no or unsure, go to question #21) |
__ Yes | __ No | __ Unsure | ||||
| 19. Who manages the surgical site infection surveillance program at your hospital? | |||||||
| Please specify:____________________ | |||||||
| 20. Is the data provided by your surgical site infection surveillance program useful? | __ Yes | __ No | |||||
| The following questions are specific torevisionTJR surgery only. | |||||||
| 21. Please indicate the number of revision total hip and total knee replacement surgeries you performed in fiscal year 2004/05. | |||||||
| Revision total hip arthroplasty | __ < 10 | __ 10–25 | __ 25–50 | __ > 50 | |||
| Revision total knee arthroplasty | __ < 10 | __ 10–25 | __ 25–50 | __ > 50 | |||
| 22. Do you ever withhold antibiotics prior to obtaining deep tissue specimens in revision TJR? | __ Yes | __ No | |||||
| 23. If you withhold antibiotics prior to obtaining deep tissue specimens in revision TJR, for which cases? | |||||||
| __ query infection | __ aseptic loosening | __ implant wear | __ fracture | ||||
| 24. Does your antibiotic choice for revision TJR surgery differ from primary TJR surgery? (if no, go to question #26) |
__ Yes | __ No | |||||
| 25. If your antibiotic choice differs from primary surgery, which antibiotic(s) and dose? | |||||||
| Drug:__________ | Dose:__________ | ||||||
| 26. If you use prophylactic antibiotics in cemented cases in the revision setting, please indicate antibiotic used. | |||||||
| __ surgeon-mixed, drug:__________ | dose/bag of cement:__________ | ||||||
| __ premixed commercially available product, specify:_______________ | |||||||
| 27. For revision cases, how long do you continue prophylactic antibiotics postoperatively? | |||||||
| __ as per primary case | __ longer than primary case | __ until culture results are available | |||||
Thank you for your time to complete this questionnaire.
Please return the questionnaire in the self-addressed, stamped envelope provided.