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Difficulty: MediumInfection Control and Hospital-Acquired Conditions

A 68-year-old woman is admitted to the hospital for an elective right total hip arthroplasty due to severe osteoarthritis. She has a history of type 2 diabetes mellitus, hypertension, and obesity. Her current medications include metformin, lisinopril, and acetaminophen. Vital signs are temperature 37.1°C (98.8°F), blood pressure 138/82 mmHg, pulse 76/min, and respiratory rate 14/min. Her preoperative blood glucose level is 142 mg/dL. The interprofessional team is reviewing the preoperative checklist to minimize the risk of a hospital-acquired surgical site infection. Which of the following is the most appropriate evidence-based intervention to implement for this patient?

  1. Administer intravenous cefazolin 45 minutes prior to the surgical incision.Answer
  2. B
    Remove hair at the operative site using a razor the evening prior to surgery.
  3. C
    Continue postoperative intravenous antibiotic prophylaxis for a minimum of 48 hours.
  4. D
    Initiate an insulin infusion to maintain perioperative blood glucose levels below 110 mg/dL.
  5. E
    Obtain a routine screening urine culture and treat any bacteriuria before proceeding.

Answer

Administer intravenous cefazolin 45 minutes prior to the surgical incision.
The most effective and evidence-based pharmacological intervention for preventing surgical site infections in clean orthopedic procedures is the administration of an appropriate prophylactic antibiotic (such as cefazolin) within 60 minutes prior to the surgical incision. This exact timing ensures that bactericidal tissue and serum concentrations are established by the time the skin barrier is broken.

Step-by-Step Solution

1
Identify the clinical scenario and objective.
The patient is undergoing a clean, high-stakes orthopedic procedure (total hip arthroplasty) and the goal is to prevent a surgical site infection (SSI).
Understanding the procedure type dictates the specific infection control bundle components required.
2
Evaluate standard SSI prevention protocols for clean surgeries.
Key evidence-based measures include optimal timing of prophylactic antibiotics, appropriate hair removal (clippers, not razors), maintaining normothermia, and moderate perioperative glycemic control.
Infection control guidelines emphasize these specific interventions because they have statistically proven benefits in reducing postoperative morbidity.
3
Select the correct intervention among the choices.
Administration of a first-generation cephalosporin (cefazolin) within 60 minutes before the incision is the correct standard of care.
This guarantees that the highest concentration of the antibiotic is present in the tissue at the moment the skin barrier is compromised.

Key Concept

Surgical site infection (SSI) prevention bundles include administering prophylactic antibiotics within 60 minutes prior to incision, discontinuing prophylaxis within 24 hours, utilizing clippers rather than razors for hair removal, and targeting moderate (rather than strict) glycemic control.
Estimated Time:1m 15s
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Topics

Infection Control and Hospital-Acquired Conditions

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