Abstract
Introduction
Surgical site infections (SSIs) are the most common nosocomial infections after surgery.
However, clinical guidance on how to handle any suspicious clusters of SSI in orthopaedic
surgery is missing. We report on problem analysis and solution finding following the
observation of an increased rate of SSI in trauma implant surgery.
Setting
Trauma unit of a university hospital.
Methods
Over a 2-year observation period, all patients (n = 370) following surgical stabilisation of proximal femur fractures in a trauma unit
of a university hospital were consecutively followed using a standardised case report
form. First, a retrospective cohort of 217 patients was collected for whom an increased
SSI rate was detected. Based on risk analysis, new standard perioperative procedures
were developed and implemented. The impact was evaluated in a prospective cohort of
153 comparable patients. Uni- and multivariable analysis of factors associated with
the risk for SSI was undertaken.
Results
The intervention bundle resulted in a significant reduction of an initially increased
SSI incidence of 6.9 (down) to 2.0% (p = 0.029). Multivariable analysis revealed four risk factors significantly associated
with a higher risk of SSI caused by different bacteria: duration of surgery (p = 0.002), hemiarthroplasty (p = 0.002), haematoma (p = 0.004) and the presence of two operating room staff members (p < 0.001 and 0.035).
Conclusions
A standardised prospective SSI protocol and detection system offering the simultaneous
use of data should guarantee every institution immediate alarm registration to avoid
comparable problem situations. Detailed interdisciplinary analysis followed by the
implementation of coherent interventions, based on a best-evidence structured bundle
approach, may adequately resolve similar critical incidence episodes.
Keywords
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Article info
Publication history
Accepted:
September 30,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
