Prevention of osteoporosis: from day-to-day care to antibacterial strategy

In the field of osteoporosis, infection is a serious complication that not only prolongs the patient ‘ s recovery and increases the pain, but can also lead to the failure of surgery, physical impairment and even endangerment of life. Comprehensive and effective prevention of infection is therefore essential, covering many aspects, from day-to-day care to anti-bacterial strategies.I. The essential role of daily care in the prevention of osteoporosis(i) Maintenance of clean and dry woundsCleaning and drying are the primary links in the prevention of infection for persons with osteoporosis, both post-operative and open trauma. The wounds should be replaced on a regular basis and covered with sterile dressing to avoid intrusion of external pollutants. In the course of drug exchange, medical personnel are required to strictly follow the principle of sterile operation to prevent cross-infection. The patient ‘ s own and family members should also follow the wound closely and inform the medical staff in a timely manner of the replacement if the dressing is found to be bleeding, leaching or contaminated. For example, a patient with post-breeding fractures who is in a damp environment for long periods of time is highly susceptible to bacteria and causes infection, which can lead to serious consequences such as delayed healing of the wound and osteoporosis.(ii) Skin careGood skin care is also essential for the prevention of osteoporosis. Patients should keep their skin clean, especially around fractures, and may use a mild cleaning agent for washing, while avoiding excessive friction and skin damage. In the case of long-term bed patients, special attention is paid to preventing the formation of crumbs, time-lapse, massage and pressure, and to keeping the blood circulation of the skin open. Because, once the skin is broken, such as scabies, bacteria can enter, spread along the blood cycle or inter-organizational gap, causing deep tissue infections such as osteoporosis.(iii) Nutritional supportSound nutritional intake is important for increasing the resilience of patients and preventing infection. Osteoporosis patients should be guaranteed sufficient intake of nutrients such as proteins, vitamins and minerals. Protein is an important raw material for body restoration and the maintenance of immune functions, which can be obtained from foods such as skinny meat, fish, eggs, beans, etc. Vitamins C, D, etc. also play a key role in bone healing and immunisation, and fresh fruits, vegetables and dairy products are a good source of these vitamins. Vitamin C, for example, promotes the synthesis of gelatin proteins and helps heal wounds; vitamin D helps to absorb and use calcium, enhances bone strength and regulates the functioning of immunocells.II. Critical measures to prevent infections in osteoporosis(i) Pre-operative preparationPatient assessmentPrior to the operation, the doctor should make a comprehensive assessment of the whole patient ‘ s condition, including the patient ‘ s underlying diseases (e.g. diabetes, cardiovascular diseases, etc.), the immune function, and the presence of an infected stove. For patients with diabetes, blood sugar levels should be actively controlled, as high blood sugar conditions are conducive to bacteria ‘ growth and reproduction and increase the risk of surgical infections. Persons with other areas of infection, such as respiratory infections, urinary system infections, etc., should be treated first, pending control of the infection before performing an osteoporosis.2. Skin preparationSkin preparation in surgical areas is an important step in preventing surgical infections. The surgical parts and their surroundings should be thoroughly cleaned and hair, dirt and grease removed prior to the operation. Traditional shaving methods may cause skin damage and increase the risk of infection, and now more methods of cutting or detanating are used. Furthermore, skin preparation times should not be premature and are generally performed in pre-operative anesthesia preparation rooms to reduce the chance of replanting the skin surface bacteria.(ii) Operations1. Bacillus technologyIn the course of surgery, strict sterile technology is at the heart of prevention. The environment in the operating theatre should be kept clean and disinfected and the surgeon should wear sterile surgical clothing, gloves and use sterile equipment and dressing. The surgical area should be subjected to strict disinfection and towels to ensure that an sterile barrier is built around the surgical cut. In the course of the operation, contact with non-bacterial areas, such as surgical devices, dressings and so forth, is to be avoided and the bacterial procedure is to be prevented. For example, an artificial joint replacement operation, which, once contaminated by bacteria, increases significantly the risk of post-operative joint infections, may result in the loss of joint functions, requiring two or even more operations, causing enormous suffering and financial burdens on patients.2. Reduction in the length of operationsThe longer the operation takes, the longer the surgical cut is exposed to air and the higher the risk of infection. The surgeon should therefore keep the operation as short as possible, while ensuring its quality. This requires skilled surgical skills, good teamwork and adequate pre-operative preparation by the surgical team, including well-designed surgical programmes and the preparation of surgical instruments.(iii) Post-operative management1. Wound carePost-operative injury care continues to focus on keeping clean and dry, with regular changes of medication in accordance with sterile operating principles. At the same time, the healing of the wounds should be closely observed, including signs of infection such as red and red, seepage, fever and increased pain. If abnormalities are detected, they should be treated in a timely manner, for example, through the development of a circulatory wound and the selection of appropriate antibacterial drugs based on the results of the process.Drainage managementIn the case of patients who have been placed with a diversion tube, it shall be properly fixed to prevent distortion, pressure and fall. Keep the flow pipe open and accurately record the volume, colour and nature of the flow fluid. The lead tube should not be placed for too long, and is usually removed in a timely manner, depending on the patient ‘ s specific circumstances, when the flow is reduced to a certain extent, in order to reduce the path to infection.III. Application of antibacterial strategies in the prevention of osteoporosis(i) Principles for anti-bacterial preventive applications1. Reasonable choice of drugsNot all osteopaedic surgery requires the preventive use of anti-bacterial drugs, which should be reasonably chosen on the basis of the type of operation, the potential bacteria and the individual circumstances of the patient. For example, antibacterial drugs may not be used for clean operations (e.g., simple closed fractures), if the procedure is short-lived and the patient is not at risk of infection, while preventive use of antibacterial drugs is required for clean-polluting operations (e.g., open fracture sutures) or polluting operations (e.g., chronic osteoporosis stove removal). In the choice of drugs, most of the drugs that are effective for common osteopathic infections, such as yellow grapes, such as antibiotics, are generally preferred. For patients with a high risk factor of MRSA infection, care may be taken to prevent the use of glucin-like antibiotics such as vancomicin.2. Correct timing and course of treatmentThe timing of the delivery of antibacterial drugs is critical and should normally be 30 minutes to 1 hour before the start of the operation, so that the blood and tissue levels of the drugs in the operation are at an effective microbicide level. Post-operative drug treatment should also be determined on the basis of the type of operation and the patient ‘ s condition, after general clean-up surgery for no more than 24 hours, after cleaning-polluting surgery for no more than 24 – 48 hours, and after the operation for an appropriate length of time depending on the infection, but the long-term use of antibacterial drugs should be avoided in order to prevent bacterial resistance.(ii) Therapeutic applications of antibacterial drugsWhen an osteoporosis patient has already contracted an infection, targeted antibacterial treatment should be based on the type of infection, the severity of the infection, the type of bacteria that causes it, etc. In the first instance, the bacterial development and sensitisation of the wound, or tissue, should be conducted in a timely manner, and sensitive anti-bacterial drugs should be selected on the basis of the sensitive results. While waiting for the results of the drug sensitivity, a wide range of antibacterial drugs can be selected for treatment based on experience, but should be adjusted to sensitive drugs in a timely manner once the results are available. For severe osteoporosis infections, such as acute osteoporosis, joint antibacterial drugs may be needed to enhance antibacterial effects, with attention to adverse effects of the drug and regular monitoring of indicators such as liver and kidney function, blood protocol, etc.The prevention of osteoporosis is a systematic project that needs to start with every detail of day-to-day care, to be strictly closed at all stages of the operation and to apply a rational antibacterial strategy. Only in this way will it be possible to effectively reduce the incidence of osteoporosis, improve the treatment and quality of life of osteoporosis patients and promote their early recovery.