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Multifaceted aseptic protocol decreases surgical site infections following hip arthroplasty
Ryan E Harold1, Bennet A Butler1, Joseph Lamplot2
11 Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago - USA.
Introduction:
We investigate the effectiveness of a comprehensive aseptic protocol in reducing surgical site infection (SSI) after hip arthroplasty in a single medical centre with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA).
Methods:
A prospectively collected database of all patients undergoing hip arthroplasty in a single centre between 2005 and 2011 was reviewed for SSI using Centers for Disease Control (CDC) criteria and AAOS guidelines. All patients were administered an aseptic protocol consisting of: 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 hip arthroplasty SSI rate to our institutional historical control and to contemporary literature.
Results:
Among 774 patients, 69% were ASA>2, 45% had BMI≥30 and 10.3% had rheumatoid arthritis. We found an overall 0.39% infection rate; significantly lower than our institutional historical control (0.39% vs. 2.60%, p<0.001, OR 0.15, NNT 200) and significantly lower than 6 published reports (p<0.001-0.022, OR 0.16-0.22). Compared to these cohorts, significantly more of our patients were ASA>2, had BMI≥30 or had rheumatoid arthritis. Patients with 3 or more identifiable risk factors were at an increased risk of SSI compared to those with 2 or fewer risk factors.
Conclusions:
Our aseptic protocol decreases SSI in a high-risk population undergoing hip arthroplasty in a medical centre and community with a high prevalence of MRSA.
Insights
A new aseptic protocol significantly reduced surgical site infections (SSI) after hip arthroplasty, even in high-risk patients. This comprehensive approach is effective in methicillin-resistant Staphylococcus aureus (MRSA)-prevalent areas.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Control
- Public Health
Background:
- Surgical site infections (SSI) pose a significant risk in hip arthroplasty.
- High prevalence of methicillin-resistant Staphylococcus aureus (MRSA) complicates infection control.
- A need exists for effective aseptic protocols in high-risk surgical settings.
Purpose of the Study:
- To evaluate the efficacy of a comprehensive aseptic protocol in reducing SSI after hip arthroplasty.
- To assess the protocol's effectiveness in a medical center with a high MRSA prevalence.
- To compare the SSI rate with historical controls and existing literature.
Main Methods:
- A prospective database of hip arthroplasty patients (2005-2011) was reviewed for SSI.
- The aseptic protocol included: mupirocin nasal ointment, chlorhexidine wipes, modified instrument care, vancomycin/cefazolin prophylaxis, and specific skin preparation.
- SSI rates were compared to institutional historical data and published studies.
Main Results:
- An overall SSI rate of 0.39% was observed in 774 patients.
- This rate was significantly lower than the institutional historical control (2.60%, p<0.001) and published reports (p<0.001-0.022).
- Patients with 3+ risk factors (e.g., ASA>2, BMI≥30, rheumatoid arthritis) had increased SSI risk.
Conclusions:
- The implemented aseptic protocol effectively decreases SSI in hip arthroplasty patients.
- The protocol demonstrates significant benefit in a high-risk population within a MRSA-prevalent community.
- This strategy offers a valuable approach to enhancing surgical safety in orthopedic procedures.
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