Effect of multidimensional intervention to reduce surgical site infection rate after knee and hip arthroplasty

Prevention strategies are critical to reduce infection rates in joint arthroplasty. This study aimed to investigate the effectiveness of a set of evidence-based practices to reduce surgical site infection (SSI) rates after knee and hip arthroplasty (HPRO & KPRO).

A quasi-experimental study design (comparing pre- and post-intervention phases) was applied. Interventions were selected, adapted, and implemented in knee and hip arthroplasty procedures as a prospective practice. They consisted of 13 processes throughout the surgical encounter, including preoperative, intraoperative, and postoperative elements.

Regarding hip arthroplasty procedures, the overall SSI rate during the pre-intervention period was 11.9%, which was reduced significantly to 5.1% (57% reduction) in the intervention period (p=0.042). For knee arthroplasty procedures, the overall baseline SSI rate during the pre-intervention period was 2.7%, which was reduced to 2.0% (26% reduction) in the intervention period. However, this reduction was not statistically significant (p=0.561). Combined methicillin-resistant Staphylococcus aureus (MRSA) screening with appropriate decolonization and targeted prophylaxis were associated with a 50% reduction in SSI caused by MRSA in knee arthroplasty.

The implementation of multidimensional evidence-based practices was associated with a reduction in SSI following knee and hip arthroplasties.