Jointing Together: A Multifaceted Approach to Reduce Joint Surgical Site Infections in a Community Hospital Setting

• Published in: American journal of infection control 2020-08, Vol.48 (8), p.S45-S45
• Main Authors: Zancocchio, Tory, Nahass, Ron, O'Herlihy, Marcella, Kayiaros, Stephen, John, Sunitha, Parrillo, Sharon L.
• Format: Article
• Language: English
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2020.06.051

Utilizing the National Healthcare Safety Network (NHSN) definition, Infection Prevention (IP) identified 6 surgical site infections (SSI) in joint replacement surgeries in 2018 first quarter (Q1) to third quarter (Q3); a troubling increase from a rate of 0.22, representing one joint SSI in 2017. The cases showed no common organism, surgeon or other surgical staff, which made single target interventions unlikely to be successful. Therefore, a multi-factorial approach needed to be developed to prevent further infections. A multi-disciplinary team was formed consisting of orthopedic surgeons, surgical performance improvement coordinator, orthopedic nursing unit registered nurse, environmental services, perioperative leadership, the hospital joint program coordinator, and the IP team including hospital epidemiologist. The group discussed challenges and identified interventions that could be accomplished immediately to include completing nasal decolonization prior to chlorhexidine gluconate (CHG) cleansing of surgical field, replacing blue wrapped instrumentation with stainless steel containers, a standardized irrigation solution (Betadine) to be used intraoperatively, dedicated staff to clean in the operating room suite, and creation of a terminal cleaning log. Interventions were rolled out starting the end of Q3 2018 and continued into the early part of 2019. The combined joint infection rate for 2019 year to date is 0.33, representing 2 hip infections. This is a 64% reduction in the rate of infection over 2018, which had 6 cases and a rate of 0.92. The implementation of interventions coincided with a reduction in the number of prosthetic joint infections over the course of one year. The impact is especially notable given that the number of cases performed year to date in 2019 is trending 18% higher than in 2018, in comparing the same time period. The response to this increased incidence of surgical site infections shows the value of collaboration between different disciplines and standardization of practices.