Electronic Letters to:

Arthroplasty: M. Al-Maiyah, D. Hill, A. Bajwa, S. Slater, P. Patil, A. Port, and P. J. Gregg Bacterial contaminants and antibiotic prophylaxis in total hip arthroplasty J Bone Joint Surg Br 2005; 87-B: 1256-1258 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Antibiotic for hip arthroplasty

Harish V Kurup   (15 November 2005)

Antibiotic for hip arthroplasty 15 November 2005
Harish V Kurup, Specialist registrar in Orthopaedics Ysbyty Gwynedd, Bangor, Wales Send letter to journal: Re: Antibiotic for hip arthroplasty harishvk{at}yahoo.com Harish V Kurup	Sir, I have read this article with great interest. After comparing it with the previous article by the same authors1 (called first study hereafter) I have some interesting observations. 1. Both the articles are based on the same study group. The authors do not comment on this. There were 627 gloves tested and 106 isolates with the same mix of isolates in the first study as well. 2. If one was looking at wound contamination in hip arthroplasty, it might be better to take samples from the wound rather than gloves of the scrub nurse which are unlikely to be near the wound. The authors have not used the opportunity to comment on whether there was any difference in the flora isolated between the surgeons' and nurses’ gloves. 3. In the first study, gloves were changed whenever there was a visible puncture. Assuming that the glove was contaminated at that point, keeping the inner glove on would have increased the chance of the next glove being contaminated to start with. Proving or disproving this hypothesis in the present study should have given valuable information as to whether both gloves need to be changed in the event of a puncture or not. This has been suggested by previous authors who also recommend disinfecting the hands2. 4. The authors have taken gloves from different time periods during surgery: after draping, at intervals of 20 minutes, before cementing etc. Did they observe any difference in isolates or contamination rates between these groups? 5. Is there definite evidence that sensitivity testing for Flucloxacillin indicates sensitivity to Cefuroxime as well? The authors have tested E. Coli with Cefuroxime and so could have done the same with all isolates to reach a more definitive answer. H.KURUP Specialist Registrar in Orthopaedics, Ysbyty Gwynedd, Bangor, North Wales 1.Al-Maiyah M, Bajwa A, Mackenney P, et al. Glove perforation and contamination in primary total hip arthroplasty. J Bone Joint Surg [Br] 2005;87-B:556-9. 2.Eklund AM, Ojajarvi J, Laitinen K, et al. Glove punctures and postoperative skin flora of hands in cardiac surgery. Ann Thorac Surg. 2002;Jul:74(1):149-53.