Bundled-Care Program for the Prevention of Surgical-Site Infections Following Lower Extremity Total Joint Arthroplasty

Surgical-site infections (SSIs) are among the most difficult-to-manage complications after lower extremity total joint arthroplasty (TJA). While the rates of most implant-related complications have decreased over time due to improvements in prosthetic materials and surgical techniques, the incidence of periprosthetic joint infections (PJIs) continues to increase. They place a tremendous economic burden on healthcare systems that is projected to reach $1.8 billion by the year 2030. A number of perioperative infection mitigation strategies exist that are often implemented concurrently to minimize the risk of these complications. A multicenter randomized controlled trial is underway to evaluate the efficacy of a bundled care program for the prevention of PJIs in lower extremity TJA. This bundle includes five infection-reduction strategies that are used pre-, peri-, and postoperatively, including: (1) povidone-iodine skin preparation and nasal decolonization; (2) iodine-alcohol surgical prepping solution; (3) iodophor-impregnated incise drapes; (4) forced-air warming blankets; and (5) negative pressure wound therapy for select patients. The aim of this review is to describe these products and their appropriate usage, review the available literature evaluating their use, and compare them with other commercially available products. Based on the available literature, each of these strategies appear to be important components for SSI-prevention protocols. We believe that implementing all five of these mitigation strategies concurrently will lead to a synergistic effect for infection control following lower extremity TJA.