Background

Infection risk: Prevention and interdisciplinary collaboration are crucial

Periprosthetic infections are a serious complication in joint implantation. Dr. Sebastian Meller heads the Section for Hip Surgery and Peri-Implant Infections at the Charité University Hospital Berlin, Campus Virchow Klinikum, and explains which patient-related and surgical risk factors play a role. Despite clear recommendations and modern hygiene standards, consistent implementation is lacking in this country – especially in cross-sectoral care. We spoke with Dr. Meller about the measures he would like to see for better, comprehensive prevention.

What risk factors can promote infection?

Dr. Meller: Periprosthetic infections are challenging complications. They arise from the interplay of various risk factors. These include patient-related chronic diseases such as diabetes mellitus, obesity, immunosuppression, nicotine consumption, or rheumatological diseases. Local factors such as chronic skin diseases or sources of infection – for example, in the dental, urogenital, or nasopharyngeal tract – also increase the risk.

Surgical-related factors include the duration of the procedure, the implants used, the need for transfusions, and the surgical technique. Perioperative factors such as blood glucose control or perioperative temperature also have an impact.

Germany is quite well positioned in terms of recommendations and standards, isn’t it?

Dr. Meller: That’s right. The recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute are well established. Last year, the Society for Endoprosthetics (AE) also published updated recommendations for the standardization of perioperative management, particularly regarding antibiotic prophylaxis, MRSA decolonization, and optimized patient preparation. Many certified endoprosthetic centers have implemented comprehensive hygiene concepts based on these recommendations and standards.

Particular attention is now paid to hygiene measures: preoperative antiseptic washing, MRSA screening with decolonization, standardized skin disinfection, correct antibiotic prophylaxis, and sterile surgical conditions—including staff discipline in the operating room. These factors are crucial for prevention.

Nevertheless, we see that implementation is not comprehensive and uniform: Some hospitals, like us, have an interdisciplinary board, others do not. Even the implementation of simple measures – such as antiseptic full-body washing before procedures or consistent dental hygiene – is not always systematic.

So, we don’t have a lack of knowledge, but rather a need for comprehensive and structured implementation of the recommendations and standards.

What reasons do you see for this?

Dr. Meller: The reasons are varied. For one thing, our endoprosthetic patients are getting older and sicker. Or to put it another way: Thanks to our medical and technological advances, we can now operate on people we wouldn’t have been able to treat a few years ago.

In hospitals, we see varying levels of resource allocation, a lack of time and staff, a lack of interdisciplinary structures, and economic pressure. Take, for example, our multidisciplinary extremity board, in which we discuss around 100 difficult cases per year presented to us from all over Germany and internationally. Maintaining such structures is productive, but also complex and costly. Here, I would like to see a development toward the creation of centers.

In addition, cross-sectoral care in Germany is a challenge, especially for elective procedures. For example, many patients present for surgery with inadequately treated infections or poorly controlled diabetes.

How can we improve here?

Dr. Meller: I believe a structured, interdisciplinary prevention concept is necessary. This includes a standardized preoperative assessment of patients, the involvement of general practitioners and dentists, and patient-specific action plans.

Digital tools for risk stratification, checklists, and better communication between healthcare sectors can be of great help here.

Consistent data collection is also crucial, for example, via the German Endoprosthesis Register. We implemented a new “infection module” here in 2025.

In your clinic at the Charité, you lead the focus on “Implant Site Infections.” How do you approach this topic in your hospital?

Dr. Meller: All patients undergo a thorough preoperative examination that follows a clearly defined preventive care pathway. This includes:

• dental treatment if necessary,
• standardized antibiotic prophylaxis,
• MRSA screening and decolonization if necessary,
• preoperative skin washing with antiseptic solutions,
• and structured postoperative wound care.

In addition, in collaboration with primary care physicians or internal medicine specialists, we strive to optimize patient preoperative care with regard to risk factors such as blood sugar control, coagulation, or immunosuppression.