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

Samar Saeed Morsi; Abeer Omar; Gautam Hebbar; Mariam Al-Fadhli; Wafaa S Hamza

doi:10.18683/germs.2021.1236

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

Germs. 2021 Mar 15;11(1):10-22. doi: 10.18683/germs.2021.1236. eCollection 2021 Mar.

Authors

Samar Saeed Morsi¹, Abeer Omar², Gautam Hebbar³, Mariam Al-Fadhli⁴, Wafaa S Hamza⁵

Affiliations

¹ PhD, Associate Professor at Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt, Consultant of Infection Control, Al-Razi Orthopedic Hospital, Kuwait, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait.
² PhD, Head of Surveillance Department, at Infection Control Directorate, Ministry of Health, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait.
³ MPH, Epidemiologist at Infection Control Directorate, Ministry of Health, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait.
⁴ PhD, Former Director of Infection Control Directorate, Ministry of Health, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait.
⁵ PhD, Associate Professor at Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt, Consultant of Infection Control at Infection Control Directorate, Ministry of Health, Kuwait, Sabah health region, P.O. Box: 12414 Alshamiya.

Abstract

Introduction: 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).

Methods: 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.

Results: 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.

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

Keywords: Evidence-based practice; hip arthroplasty; knee arthroplasty; methicillin-resistant Staphylococcus aureus; surgical site infection.

GERMS.