infections involving periarticular injections 891
external catheters are used to infuse analgesic medications. Finally, many surgeons include corticosteroids as an adjuvant medication in these injections, which may increase the risk of infection. Our survey of community hospitals revealed widespread use
of PAIs without standardization of drug composition, compounding techniques, and method of administration. We were unable to prove that PAIs were responsible for the 4 clusters of SSI reported above. These outbreaks stopped after a number of interventions were undertaken, including standar- dization of compounding techniques or discontinuation of PAIs. The use of PAIs and the associated risks of infection may lead to sporadic occurrences or clusters of SSIs at other hospitals. However, it is difficult to determine the cause of small clusters of SSIs, and publication bias may limit evalua- tion of PAI safety. Therefore, hospital epidemiologists and surgeons should be aware of these potential risks, especially if an increase in rates of SSI following joint replacement surgeries occurs at their institution.
acknowledgments
Financial support: No financial support was provided relevant to this article. Potential conflicts of interest: All authors report no conflicts of interest relevant to this article.
Jessica Seidelman, MD;1,2 ArthurW. Baker, MD, MPH;1,2
Deverick J. Anderson, MD, MPH;1,2 Daniel J. Sexton, MD;1,2
Sarah S. Lewis, MD, MPH1,2
Affiliations: 1. Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina; 2. Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.
Address correspondence to Jessica Seidelman, 310 Trent Drive, Hanes House Room 181, Durham, NC 27710 (
jessica.seidelman@
duke.edu).
Infect Control Hosp Epidemiol 2018;39:889–891 © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3907-0025. DOI: 10.1017/ice.2018.80
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