Hospital Germs and Washing Before Hip and Knee Surgery
Concern about “hospital germs” is one of the most common questions before a hip or knee replacement. Many patients want to know how high the risk of infection really is, whether special washing is necessary, and what they can do themselves. The reassuring news is: a deep infection is a serious but rare complication. Before and during the operation, several protective measures work together.
Key points at a glance:
- “Hospital germ” is a colloquial collective term. Not every germ is resistant, and colonization is not yet an infection.
- Showering or bathing before surgery reduces the number of germs on the skin. It does not make the skin sterile and does not replace other protective measures.
- According to the WHO, both normal and antimicrobial soap are generally possible. If the hospital specifies a particular product, that specific instruction applies.
- The surgical area should not be shaved at home. If hair needs to be removed, the treatment team will do this using a suitable hair clipper.
- Fever, new infections, inflamed skin areas, and known MRSA colonization should be reported before the operation. This does not automatically lead to a cancellation.
Priv.-Doz. DDr. Maximilian Kasparek, MSc specializes in hip and knee arthroplasty. During the consultation, he assesses the personal risk and explains which preparation is sensible for the planned procedure.
“The most important message is: an infection after a hip or knee replacement is rare. We still take the issue very seriously because several well-coordinated measures can further reduce the risk.” – Dr. Maximilian Kasparek
What the term hospital germ means
The term “hospital germ” does not refer to a single pathogen. It usually refers to bacteria that can cause an infection in connection with medical treatment. This also includes germs that many people already carry on their skin or in their nose without being ill. Staphylococcus aureus is frequently mentioned. If this germ is resistant to certain antibiotics, it is referred to as MRSA, among other things.
The distinction between colonization and infection is important. In colonization, a germ is detectable but causes no symptoms. An infection only exists when germs penetrate tissue and trigger an inflammatory reaction or disease. A positive swab therefore does not automatically mean that someone is ill or cannot be operated on.
Also, “resistant” and “particularly aggressive” are not the same thing. Resistance means that certain antibiotics do not work sufficiently. This can make treatment more difficult, but in itself says nothing about whether an infection will develop.
How high the risk of infection is after joint replacement
A periprosthetic joint infection affects the area around an artificial joint. It occurs in only a small proportion of patients after a primary hip or knee replacement. The specific risk depends, among other things, on general health, comorbidities, skin condition, the procedure, and how a study records an infection.
An Australian data linkage study on primary joint replacements for osteoarthritis evaluated registry and hospital data from 2002 to 2017. Within 90 days, the average rate of periprosthetic joint infection recorded via diagnosis codes was 1.1 percent after hip replacement and 1.3 percent after knee replacement. These values are a guide for large patient groups and not a personal prediction.
STUDY BRIEF INFO
Infections after joint replacement are rare.
Average 90-day rate of periprosthetic joint infection.
Hip replacement
Primary joint replacement for osteoarthritis
1,1%
within 90 days
Knee replacement
Primary joint replacement for osteoarthritis
1,1%
within 90 days
Context
The study linked Australian registry and hospital data from 2002 to 2017. Personal risk may vary depending on health, procedure, and recording method.
Source: Jin et al., Bone Joint | 2022;104‑B: 1060–1066 • DOI 10.1302/0301–620X.104B9.B||-2022–0116.R1
In other words: for the vast majority, no such recorded infection occurred within this period. Because a joint infection can nevertheless be serious, the risk is reduced not by a single measure, but by an entire safety concept.
Why washing before surgery is useful
Many bacteria naturally live on healthy skin. A shower or bath before surgery removes dirt and temporarily present germs and reduces the bacterial load on the skin. The WHO therefore recommends showering or bathing before an operation. It specifies the day of surgery or the day or evening before as the time.
Washing does not make the skin germ-free. It is a preparatory building block. Other important measures take place in the hospital, including skin checks, antiseptic preparation of the surgical area, antibiotic prophylaxis at the right time, and a sterile procedure in the operating room.
“Washing before surgery is useful because it reduces the number of germs on the skin. However, it is only one part of the protection concept and cannot set the risk to zero on its own.” – Dr. Maximilian Kasparek
Normal soap or antiseptic washing
For general preoperative body washing, the WHO allows both normal and antimicrobial soap. In the studies evaluated, soap containing chlorhexidine showed no additional advantage over normal soap in the rate of wound infections. However, this does not mean that an antiseptic product prescribed by the hospital should be omitted.
Some hospitals use specific washing or decolonization programs for joint operations. In the case of known colonization with Staphylococcus aureus or MRSA, targeted treatment may also be useful, for example with a prescribed nasal ointment and an antiseptic body wash. Whether a swab or such decolonization is necessary is decided by the treatment team according to the respective protocol and individual risk.
The safe rule is therefore: use exactly the product, frequency, and timing specified by the hospital. Do not use concentrated disinfectants and do not combine products on your own. In case of skin irritation, allergies, or uncertainties, ask before use.
How to prepare the skin correctly
- Shower or bath at the specified time and wash the whole body carefully.
- Use the recommended soap or prescribed washing product exactly as instructed.
- Avoid the eyes, ears, mucous membranes, and other sensitive areas unless the product instructions state otherwise.
- Dry yourself with a clean towel and put on clean clothes.
- Afterward, do not apply any cream, lotion, or body oils to the intended surgical area if this is specified in your documents.
- Do not shave or epilate the surgical area yourself. Small skin injuries are avoidable.
If your personal documents differ from this general overview, the specific instructions from your hospital apply. Ask if the procedure is not clearly described.
Why you should not shave the surgical area yourself
A razor blade can cause very small, often invisible injuries. These skin damages can make it easier for germs to enter. WHO and NICE therefore advise against routine hair removal. If hair could interfere with the procedure, it will be shortened by the treatment team shortly before the operation using a suitable clipper.
What you must report before the operation
Please inform the surgical team as early as possible if a new health change occurs shortly before the procedure. This includes in particular:
- Fever, chills, or a pronounced feeling of illness,
- an inflamed wound, weeping eczema, a skin ulcer, or a suspicious skin area near the surgical site,
- a new respiratory infection or other clear signs of infection,
- new complaints when urinating,
- a known MRSA or other resistant germ colonization,
- current antibiotic treatment or a recently treated infection.
“If you notice a fever, an inflamed skin area, or a new infection shortly before the operation, please let us know. This does not automatically mean that the procedure will be canceled. We will check which solution is medically safe.” – Dr. Maximilian Kasparek
What happens in the case of known MRSA colonization
A known MRSA colonization should already be stated during surgical planning. The team can then decide in good time whether a new swab, decolonization, or special hygiene measures are required. Colonization is not an acute infection and does not automatically lead to cancellation. The current findings and the protocol of the treating hospital are decisive.
Do not take antibiotics as a precaution. Antibiotics only reliably prevent an infection if the active ingredient, dose, and timing match the operation and the personal situation. Perioperative antibiotic prophylaxis is therefore planned by the treatment team.
What additional protective measures are taken in the hospital
Preparation at home is important, but it does not carry the safety concept alone. In the hospital, several standardized measures are added:
- Checking the skin and clarifying suspicious findings before the procedure,
- Antibiotic prophylaxis so that an effective concentration is present at the start of the operation,
- professional antiseptic preparation of the skin in the operating room,
- sterile instruments, sterile draping, and established procedures of the surgical team,
- appropriate blood sugar and temperature control as well as careful wound care.
No single step offers complete protection. The low infection rates of modern joint operations are based on the interplay of these measures.
What you can influence yourself
Not every risk factor can be changed. However, some points can be optimized together before a planned operation. These include the most stable blood sugar control possible in diabetes, smoking cessation, treatment of open skin areas, and full disclosure of all medications and previous illnesses. Radical diets or short-term self-treatment immediately before the procedure are not sensible. Discuss realistic measures early on with the treating team.
Personal Surgical Consultation in Vienna
How high your personal risk is depends on the procedure and your health. In a surgical consultation, you can discuss findings, preparation, and open questions in peace. You can find information on hip osteoarthritis as well as knee osteoarthritis. Depending on the findings, different procedures may be considered, such as minimally invasive hip replacement or a robotic-assisted knee replacement. The selection is made individually.
Frequently Asked Questions About Hospital Germs and Washing Before Surgery
How high is the risk of infection after a hip or knee replacement?
The risk is low, but not zero. Large studies and professional societies usually cite a low single-digit percentage range for primary hip and knee replacements. Personal risk depends on health, procedure, observation period, and definition of infection.
Is every hospital germ multi-resistant?
No. “Hospital germ” is a colloquial collective term. Many wound infections are caused by bacteria that occur on one’s own skin or in the nose. Only a part of them is resistant to several antibiotics.
Is MRSA colonization already an infection?
No. In colonization, MRSA is detectable but causes no disease. Nevertheless, the surgical team must be informed because targeted decolonization or additional hygiene measures may be useful.
Do I need an MRSA swab before every hip or knee operation?
Not automatically. Screening programs differ according to hospital and risk profile. Whether a swab is useful is decided by the treating team.
Is normal showering before surgery enough?
WHO guidelines allow normal or antimicrobial soap for general body washing. If your hospital has prescribed a specific antiseptic product, follow that instruction exactly.
When should I shower before the operation?
The WHO specifies the day of surgery or the day or evening before. The specific schedule in your surgical documents is authoritative.
Does antiseptic washing prevent every infection?
No. It reduces the number of germs on the skin but does not make the skin sterile. Protection is created by several measures before, during, and after the operation.
Should I shave my leg or groin before the operation?
No. Do not shave the surgical area yourself. If hair removal is necessary, it is done shortly before the operation by the treatment team using a suitable clipper.
What do I do if I have a pimple or a small wound near the surgical area?
Report the skin change before the procedure. Please do not squeeze, scratch, or treat it yourself with antibiotics. The team will decide whether a check or treatment is required.
Is the operation always postponed if there is an infection?
No. The decision depends on the type, severity, and location of the infection as well as the urgency of the procedure. Report symptoms early so that a safe decision can be made.
Can I take antibiotics as a precaution?
No. Take antibiotics only as prescribed by a doctor. For prophylaxis around the operation, the active ingredient, dose, and timing are precisely defined.
What warning signs should I watch out for after the operation?
Increasing redness or swelling, persistent wound secretion, significantly increasing pain, chills, or a strong feeling of illness should be clarified by a doctor promptly. Your specific discharge documents contain the contact details relevant to you.
Where can I discuss my personal preparation?
Priv.-Doz. DDr. Maximilian Kasparek, MSc offers personal surgical consultation and second opinions on hip and knee replacements in Vienna. Appointments can be booked directly online.
Medical Note
This article is for general information purposes and does not replace a personal examination or the specific instructions of the treating hospital. In case of acute symptoms, fever, or a suspicious wound, contact your treatment team.
If you enjoyed this article, you might also be interested in other posts from our blog.
