THE ROLE OF HEALTH PROFESSIONALS IN THE PREVENTION OF KNEE PROTHETIC INFECTIONS AND PRINCIPLES OF TREATMENT

Teoretično izhodišče. V magistrskem delu smo predstavili anatomijo in fiziologijo kolenskega sklepa in obolenja, ki privedejo do artroze kolena. Zamenjava kolenskega sklepa z umetnim je danes pogost način zdravljenja, ki pacientom izboljša kakovost življenja. S posegom je povezano tveganje za nastanek okužbe, ki jo skušamo preprečiti s različnimi postopki za preprečevanje poznejših okužb. Uporabljena je bila retrogradna analiza popisov pacientov, ki so se v Splošni bolnišnici Celje zdravili zaradi okužbe kolenskih vsadkov v obdobju 2000 – 2010, ter pregled podatkov o povzročiteljih okužb iz baze podatkov Mikrobiološkega laboratorija Zavoda za zdravstveno varstvo Celje. Rezultati raziskave. Rezultati analize podatkov so pokazali, da se je v 10 - letnem obdobju na Oddelku za ortopedijo in športne poškodbe zaradi okužbe kolenskega sklepa zdravilo 26 pacientov12 moških in 14 žensk, starih od 45 do 90 let. Delež okužb se je gibal med 0 – 5,3 % letno, glede na vse operirane paciente v tistem obdobju. Najpogostejši povzročitelji so bili Staphylococcus aureus, in sicer pri 12 pacientih (20 %), sledili so Streptococcus in Enterobacteriaceae. Diabetes se je izkazal kot pomemben dejavnik tveganja za nastanek okužbe pri zgodnjih in odloženih okužbah, medtem, ko ostalih dejavnikov tveganja, povezanih s pacientom in operativnim posegom ne moremo potrditi zaradi premajhnega raziskovalnega vzorca. Ugotovljeno je, da lahko tudi manjši raziskovalni vzorec v zadostni meri omogoča vrednotenje kakovosti dela v posamezni instituciji. Dosledno spremljanje in evidentiranje okužb sklepnih vsadkov omogoča uvedbo izboljšav, ki zmanjšujejo pojavnost okužb na minimalni nivo, kar ima ugoden učinek tako za pacienta kot tudi za zdravstveno blagajno. K temu pa zagotovo pripomoreta ustrezna perioperativna antibiotična zaščita in ustrezna tehnična izvedba operacije.In this thesis we presented the anatomy and physiology of the knee and inflammatory disease which can lead to degenerative arthritis of the knee. Joint replacement surgery, a very frequent and successful procedure worldwide, has greatly improved the quality of life of many patients. By that the safeguard measures at implant and procedure to prevent subsequent infections need to be implemented.The study was performed with the retrograde analysis of patients treated in General Hospital Celje in time period 2000 – 2010, as well by help of data review on infections from data base of microbiological laboratory in Celje.The results of data analysis show that we are in the 10 - year period due to an infection of the knee joint we treated 26 patients, 12 men and 14 women aged 45 to 90 years. Infection rate ranged between 0 – 5, 3% per year, considering all surgical patients during that period. The most common cause was Staphylococcus aureus, namely 12 (20 %) patients, followed by Streptococcus and Enterobacteriaceae. Diabetes has been identified as an important risk factor for wound infections in the early and delayed infections, while other risk factors associated with the patient and the surgery can not be confirmed due to the small sample research.Despite small sample research obtained results enable evaluation of work quality within particular institution. Strict monitoring and recording of implants infection enable introduction of improvements that reduce the incidence of infections to a minimum level, as a beneficial effect for both the patient and the health care budget. A technically perfect operation and perioperative antibiotic prophylaxis can decrease the incidence of surgical wound infections