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A-1390
2004 |
| Practice Redesign Reduces Surgical Site Infections (SSIs) in Total Knee Replacement Surgery |
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Morris Brown, M.D., Barbara Horvath, R.N., Patricia Stoltz, R.N., Henry Kroll, M.D., Jack Jordan, M.S. Anesthesiology, Henry Ford Hospital, Detroit, Michigan. |
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Introduction: SSIs account for 14-16% of all hospital acquired infections and are associated with a significant increase in hospital days and cost.1 As part of a Centers for Medicare and Medicaid Services sponsored national demonstration project on surgical site infection prevention, we redesigned our practices in the operating room, consistent with published guidelines2, in an effort to reduce SSIs in patients scheduled for total knee replacement surgery. Methods: All patients scheduled for elective knee replacement surgery were included. The following practices were instituted and monitored for compliance: (1) surgical site shaved just prior to incision with clippers instead of razors, (2) prophylactic antibiotics selected and ordered by protocol and administered by anesthesiologists within two hours prior to surgical incision and (3) antibiotics discontinued within 24 hours following surgery. SSIs were monitored using Centers for Diseases Control guidelines3 and reported as the number of knee surgeries performed between SSIs. Data was analyzed using chi square analysis with significance at p<0.05. Results: The number of cases between SSIs is outlined in figure 1. Once razors were removed from the operating rooms, there was 100% compliance with the use of clippers to prepare the surgical site just prior to incision. With practice design changes, including antibiotic selection by protocol and administration by anesthesiologists in the operating room, there was improvement in the appropriate selection (p<0.8) and on-time administration (p<0.0001) of prophylactic antibiotic therapy. There was also an increase to 96.2% compliance with the discontinuation of antibiotic therapy within 24 hours following surgery (p<0.33). Conclusion: An effective infection-prevention program can significantly reduce the rate of SSIs.4 As part of a national collaborative, using the model developed by the Institute for Healthcare Improvement, through our practice redesign we were able to reduce the incidence of SSIs in patients undergoing total knee replacement surgery. References: 1. Jarvis WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996,17(8):552-7. 2. Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999,20:247-78. 3. Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections: A modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992, 13:606. 4. Haley RW, Culver DH, White JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985, 121(2):182-205. Anesthesiology 2004; 101: A1390 |
Figure 1
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