Modified Protocol Decreases Surgical Site Infections after Total Knee Arthroplasty
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Joseph D Lamplot1, Gaurav Luther1, Emily Landon Mawdsley1
1Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Abstract:
We investigate the effectiveness of a comprehensive aseptic protocol in reducing surgical site infection (SSI) after knee arthroplasty in a single medical center with a high prevalence of MRSA. A database of all patients in a single center undergoing primary knee arthroplasty between 2005 and 2011 was reviewed for SSI using Centers for Disease Control criteria and AAOS guidelines. All patients were treated with an aseptic protocol consisting of the following: preoperative 2% mupirocin nasal ointment and 0.4% chlorhexidine surgical site wipes, modified instrument care, perioperative prophylactic vancomycin and cefazolin, and surgical site skin preparation with chlorhexidine, alcohol, and iodophor. We compare our protocol total knee arthroplasty SSI rate to our institutional historical control (2001-2004) and to contemporary literature. Among 1,224 patients, 70% were ASA class >2 and 64% had a body mass index (BMI) > 30 kg/m(2). We found an overall 0.49% infection rate, significantly lower than that of our institutional historical control (0.49 vs. 2.24%, p < 0.001; odds ratio [OR], 0.21; number needed to treat [NNT], 145) and seven recently published reports (p < 0.001-0.042; OR, 0.07-0.42). Compared with these reports, significantly more of our patients were ASA class > 2, BMI > 30 kg/m(2), immunosuppressed, or had rheumatoid arthritis. Our aseptic protocol decreases SSI in a high-risk population undergoing knee arthroplasty in a medical center and community with a high prevalence of MRSA.
Insights
A comprehensive aseptic protocol significantly reduced surgical site infections (SSI) after knee arthroplasty, even in high-risk patients. This protocol is effective in MRSA-prevalent areas.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Public Health
Background:
- Surgical site infections (SSI) are a significant complication of knee arthroplasty.
- High prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) poses challenges in infection control.
- Existing protocols may not be sufficient for high-risk patient populations.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive aseptic protocol in reducing SSI after knee arthroplasty.
- To compare SSI rates with historical controls and contemporary literature.
- To assess the protocol's efficacy in a high-risk population within an MRSA-prevalent setting.
Main Methods:
- A retrospective review of 1,224 knee arthroplasty patients (2005-2011) using Centers for Disease Control criteria.
- Implementation of a multi-faceted aseptic protocol including nasal ointment, surgical wipes, modified instrument care, and specific prophylactic antibiotics.
- Skin preparation involved chlorhexidine, alcohol, and iodophor.
Main Results:
- An overall SSI rate of 0.49% was observed.
- This rate was significantly lower than the institutional historical control (2.24%, p < 0.001).
- The protocol demonstrated significantly lower SSI rates compared to seven published reports (p < 0.001-0.042).
Conclusions:
- The comprehensive aseptic protocol effectively reduces SSI in knee arthroplasty patients.
- The protocol is particularly beneficial for high-risk individuals, including those with obesity or rheumatoid arthritis.
- This approach is valuable in medical centers and communities with a high prevalence of MRSA.
