Since we launched a total joints program nearly 3 years ago, we've performed about 200 knee and hip replacements without a single patient suffering a deep wound infection. That's no small feat for our large orthopedic practice because surgical site infections have dire consequences in joint replacement patients. Infected patients are subjected to several weeks of antibiotic treatments and often must undergo a 2-stage revision surgery to remove and replace the infected implant. Deep wound infections are also expensive to manage — it costs about $18,000 to treat a standard bacterial infection with a revision surgery and more than $100,000 to treat a MRSA SSI — with no guarantee the infection will be eradicated.

We zeroed out our SSI rate in this challenging and high-consequence patient population by focusing on these fundamental infection practices.

Joint infection patients are at high risk of infection if they have multiple comorbidities, including uncontrolled diabetes, obesity, hypertension or a compromised immune system. Efforts to prevent infection begin with appropriate patient selection and mitigating risk factors in the weeks leading up to surgery:

• smokers should kick the habit at least 6 weeks out;
• patients with a body-mass index over 38 should lose weight until their BMI is at an acceptable threshold (< 35, for example); and