Synopsis
Understand washout as structured source control rather than irrigation alone, preserve deep microbiology, match surgical access to anatomy, and connect empirical, directed and follow-up antimicrobial decisions to operative findings.
- Washout is a source-control package: adequate exposure, decompression, drainage, excision of non-viable tissue, representative sampling, dead-space management and a documented closure or re-look plan.
- Stable patients should provide blood and deep samples before antibiotics. Septic patients receive intravenous treatment after rapidly obtainable blood cultures even if theatre or aspiration is delayed.
- Take fluid before irrigation and multiple deep tissue samples with a fresh sterile instrument for each; five microbiology specimens are the BOASt standard for fracture-related and peri-prosthetic infection.
Key red flags
Shock, rising lactate, altered consciousness or progressive organ dysfunction requires immediate sepsis antibiotics and emergency source control rather than prolonged diagnostic optimisation.
Investigation priorities
Identify systemic organisms before antibiotics when rapidly possible.
Management branches
Sepsis, necrotising infection, neurovascular threat or rapidly destructive closed-space infection is present.
- Take rapid blood cultures, start intravenous therapy and mobilise theatre and critical care concurrently.
- Expose the entire threatened anatomy, obtain deep samples and drain or excise all non-viable infected tissue.
The patient is stable and a deep infection operation can be deliberately designed.
Key medicines
Empirical treatment after operative samplingImmediately after pre-irrigation fluid and deep tissue specimens are secured, give the complete adult agent, route, dose and interval from the trust's anatomical infection protocol; review at 48 hours against preliminary cultures and the operation performed.
Organism-directed continuationPrescribe the narrowest active regimen with exact route, frequency, monitoring and stop or review date agreed by infection specialists, using a reliable oral agent when appropriate and linking duration to retained implants, bone involvement, drainage and response.