Table 3.

Intra-operative measures and strategies for preventing PJI.

Measures	Strategy
Limit OR traffic	Ensuring access to frequently used instruments, utilisation of intercom, and keep door movements per surgical procedure to a minimum
Double gloving	Gloves should also be changed every 30–60 min [56]
Meticulous skin preparation	Iodine and alcohol-based solutions are recommended for skin preparation [57]. Diluted betadine is recommended by WHO and CDC [57]
Frequent change of blade	Blade change following skin incision
Reduce operative time	Prolonged operative time increases the risk of wound contamination [58]
Thorough irrigation	Pulsed lavage efficacy of eradicating organisms by 100 times greater than that of a spherical syringe [59]
Prophylactic administration of antibiotics	A first-generation cephalosporin [60] or clindamycin should be administrated within 30 minutes of the incision.Vancomycin should be considered for Methicillin-resistant Staphylococcus aureus (MRSA) colonised patients or patients with a previous MRSA infection.
Minimise blood loss	Tranexamic acid is recommended for all THA patients unless there is a significant risk of embolism [61].