Total knee arthroplasty post-op surgical site infection rate about 0.5- 5% Pre-operative , perioperative and post-operative prevention are importance for reduce surgical site infection The prevention of surgical-site infections (SSIs) is an integral component of nosocomial infection control and a major priority in orthopedic surgery.

Surgical wound contamination must be prevented to avoid patient colonisation by microorganisms during surgery.

Surgical glove changing perioperative can reduce contamination and perforation rate Orthopedic surgery had found contamination rate about 20-28 % Joint replacement procedure found contamination rate about 38-67% of all orthopedic surgery 12% of gloves are contaminated after draping and 24% once patient installation is complete.

We hypothesis that changing surgical glove during total knee arthroplasty can reduce contamination rate on surgical glove.

Total knee arthroplasty post-op surgical site infection rate about 0.5- 5% Pre-operative , perioperative and post-operative prevention are importance for reduce surgical site infection The prevention of surgical-site infections (SSIs) is an integral component of nosocomial infection control and a major priority in orthopedic surgery.

Surgical wound contamination must be prevented to avoid patient colonisation by microorganisms during surgery.

Surgical glove changing perioperative can reduce contamination and perforation rate Orthopedic surgery had found contamination rate about 20-28 % Joint replacement procedure found contamination rate about 38-67% of all orthopedic surgery 12% of gloves are contaminated after draping and 24% once patient installation is complete.

Research question : Does changing surgical glove during total knee arthroplasty can reduce contamination rate on surgical glove?

Population : Patient who schedule for primary total knee arthroplasty in Srinagarind hospital

Inclusion criteria :Patient who schedule for primary total knee arthroplasty in Srinagarind hospital

Exclusion criteria :

Patient factor Patient who had previous open knee surgery Patient who have remote infection at period of surgery for total knee arthroplasty Patient who have lower extremity infection same side at total knee arthroplasty prior 48 hrs Surgical glove factor gross perforation Glove changing not include in criteria for study group

Primary outcome :

-Comparison contamination rate of surgical glove in treatment group and control group

Secondary outcome :

-Contamination rate in draping method period and surgical procedure prior to cementation period in total knee arthroplasty

Study design: a randomized controlled trial

Treatment group glove changing after draping and before cementation glove changing before cementation Control group

-no glove change

Pre-operative protocal

• iv. Cefazolin 1 hour prior to incision
• skin preparation by Betadine scrub
• Draping including entire limb from thigh to foot
• pre-operative hand wash by Betadine scrub for at least 2 minutes Perioperative protocal
• Operating room include horizontal laminar flow
• Use Ansell GAMMEX latex powdered surgical glove for all glove include in this study Post-operative protocal
• antibiotic prophylaxis for 24 hours post-op

The five fingertips of each hand were placed on blood agar immediately before each set of gloves were removed Culture plates were subsequently incubated at 37°C for 48 hours. A single microbiologist reported the results of the culture. The number of colonies counted as the number of colony-forming units (CFU) per dish and types of organisms were recorded

identified all bacterial isolates by using Gram stain coagulase oxidase catalase tests. The degree of contamination was divided into three grades

1. no contamination if there was no growth
2. low contamination where between one and five colonies
3. heavily contaminated if there were more than five colonies

Inclusion Criteria:

• Patient who schedule for primary total knee arthroplasty

Exclusion Criteria:

• Patient who had previous history of open knee surgery Patient who have remote infection during period of total knee arthroplasty Patient who have infection around lower extremity at the same site of total knee arthroplasty

Patient and outcome assessor will be blind