Multidisciplinary Collaboration and Use of Evidence-based Bundle Reduce Surgical Site Infections Associated with Hip and Knee Arthroplasty

2016 ◽  
Vol 44 (6) ◽  
pp. S97
Author(s):  
Jean M. Albany ◽  
Dorothy Borton ◽  
Annette Yerkes ◽  
Julius Oni ◽  
Catherine Reynolds ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Site Infections ◽  
Evidence Based ◽  
Multidisciplinary Collaboration ◽  
Hip And Knee Arthroplasty

scholarly journals Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty

2018 ◽  
Vol 28 (5) ◽  
pp. 374-381 ◽  
Author(s):  
Michael S Calderwood ◽  
Deborah S Yokoe ◽  
Michael V Murphy ◽  
Katherine O DeBartolo ◽  
Kathy Duncan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Site Infections ◽  
Evidence Based ◽  
Medicare Beneficiaries ◽  
Evidence Based Practices ◽  
Lower Odds ◽  
Hip And Knee Arthroplasty ◽  
Matched Comparison

BackgroundQuality improvement (QI) campaigns appear to increase use of evidence-based practices, but their effect on health outcomes is less well studied.ObjectiveTo assess the effect of a multistate QI campaign (Project JOINTS, Joining Organizations IN Tackling SSIs) that used the Institute for Healthcare Improvement’s Rapid Spread Network to promote adoption of evidence-based surgical site infection (SSI) prevention practices.MethodsWe analysed rates of SSI among Medicare beneficiaries undergoing hip and knee arthroplasty during preintervention (May 2010 to April 2011) and postintervention (November 2011 to September 2013) periods in five states included in a multistate trial of the Project JOINTS campaign and five matched comparison states. We used generalised linear mixed effects models and a difference-in-differences approach to estimate changes in SSI outcomes.Results125 070 patients underwent hip arthroplasty in 405 hospitals in intervention states, compared with 131 787 in 525 hospitals in comparison states. 170 663 patients underwent knee arthroplasty in 397 hospitals in intervention states, compared with 196 064 in 518 hospitals in comparison states. After the campaign, patients in intervention states had a 15% lower odds of developing hip arthroplasty SSIs (OR=0.85, 95% CI 0.75 to 0.96, p=0.01) and a 12% lower odds of knee arthroplasty SSIs than patients in comparison states (OR=0.88, 95% CI 0.78 to 0.99, p=0.04).ConclusionsA larger reduction of SSI rates following hip and knee arthroplasty was shown in intervention states than in matched control states.

scholarly journals Acute kidney injury following prophylactic flucloxacillin and gentamicin in primary hip and knee arthroplasty

2020 ◽  
Author(s):  
Judi Graham ◽  
Emma Borthwick ◽  
Christopher Hill ◽  
Janine Blaney ◽  
Nicola Gallagher ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Knee Arthroplasty ◽  
Prophylactic Antibiotic ◽  
Kidney Injury ◽  
Binary Logistic Regression ◽  
Surgical Site Infections ◽  
Ideal Body Weight ◽  
High Dose ◽  
Binary Logistic Regression Model ◽  
Hip And Knee Arthroplasty

Abstract Background Following concerns regarding the emergence of Clostridium difficile infection in 2010, we changed antibiotic prophylaxis in patients undergoing primary hip and knee arthroplasty from cefuroxime to flucloxacillin and single-dose (SD) gentamicin. A subsequent perceived increase in the incidence of post-operative acute kidney injury (AKI) led us to evaluate the AKI incidence between different prophylactic antibiotic regimes used at our centre. Methods We examined the incidence of AKI as defined by Kidney Disease: Improving Global Outcomes criteria in 1588 patients undergoing primary hip or knee arthroplasty from January 2010 to January 2015. Patients received the following prophylactic antibiotic regimes: 8 g flucloxacillin in four divided doses and SD gentamicin 1.5 mg/kg ideal body weight (IBW; maximum dose 120 mg; n = 400), 8 g flucloxacillin alone in four divided doses (n = 400), SD cefuroxime (n = 400), triple-dose (TD) cefuroxime (n = 188) and teicoplanin with SD gentamicin 1.5 mg/kg IBW (n = 200). Results The incidence of AKI was as follows: flucloxacillin and gentamicin (13%); flucloxacillin alone (8.5%); SD cefuroxime (2%); TD cefuroxime (0.5%); and teicoplanin and gentamicin (3%). Of the six patients who developed Stage 3 AKI, all were in the flucloxacillin and gentamicin group. The odds ratio for the development of AKI derived from a binary logistic regression model was highest in the flucloxacillin and gentamicin group [7.79 (95% confidence interval 3.54–17.14), P < 0.0001]. Conclusions Our findings suggest that the use of prophylactic high-dose flucloxacillin and gentamicin should be used with caution in patients undergoing primary hip or knee arthroplasty without a clear advantage in reducing surgical site infections given the association with increased rates of AKI.

Evaluation of postdischarge surveillance of surgical site infections after total hip and knee arthroplasty

2005 ◽  
Vol 33 (8) ◽  
pp. 455-462 ◽  
Author(s):  
Frank Huenger ◽  
Adriane Schmachtenberg ◽  
Helga Haefner ◽  
Dirk Zolldann ◽  
Katharina Nowicki ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Site Infections ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

scholarly journals Relationship Between Staphylococcus aureus Carriage and Surgical Site Infections Following Total Hip and Knee Arthroplasty in the South Asian Population: Protocol for a Prospective Cohort Study (Preprint)

2018 ◽  
Author(s):  
Syed H Mufarrih ◽  
Nada Q Qureshi ◽  
Anum Sadruddin ◽  
Pervaiz Hashmi ◽  
Syed Faisal Mahmood ◽  
...  
Keyword(s):  
South Asian ◽  
Knee Arthroplasty ◽  
Surgical Site Infections ◽  
Asian Population ◽  
University Hospital ◽  
The South ◽  
South Asian Population ◽  
Methicillin Resistant ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

BACKGROUND Surgical site infections following total hip or knee arthroplasties have a reported rate of 0.49%-2.5% and can cause significant morbidity as well as tripling the cost of health care expenses. Both methicillin sensitive and methicillin resistant strains of Staphylococcus aureus surgical site infections have been established as a major risk factor for postoperative surgical site infections. S. aureus colonizes the nose, axillae, and perineal region in up to 20%-30% of individuals. Although the literature has reported a higher prevalence of methicillin resistant S. aureus in the South Asian population, routine preoperative screening and prophylaxis have not yet been implemented. OBJECTIVE The primary objective of our study is to identify the relationship between preoperative colonization status of S. aureus and incidence of postoperative surgical site infections in patients undergoing following total hip and knee arthroplasties. As part of the secondary objectives of this study, we will also investigate patient characteristics acting as risk factors for S. aureus colonization as well as the outcomes of total hip and knee arthroplasty patients which are affected by surgical site infections. METHODS This prospective cohort study will comprise of screening all patients older than 18 years of age admitted to the Aga Khan University Hospital for a primary total hip or knee arthroplasty for preoperative colonization with S. aureus. The patients will be followed postoperatively for up to one year following the surgery to assess the incidence of surgical site infections. The study duration will be 2 years (March 2018 to March 2020). For the purpose of screening, pooled swabs will be taken from the nose, axillae, and groin of each patient and inoculated in a brain heart infusion, followed by subculture onto mannitol salt agar and sheep blood agar. For methicillin resistant S. aureus identification, a cefoxitin disk screen will be done. Data will be analyzed using SPSS v23 and both univariate and multivariate regression analysis will be conducted. RESULTS Data collection for this study will commence at the Aga Khan University Hospital, Pakistan during March 2018. CONCLUSIONS This study will not only estimate the true burden caused by S. aureus in the population under study but will also help identify the patients at a high risk of surgical site infections so that appropriate interventions, including prophylaxis with antibiotics such as muciprocin ointment or linezolid, can be made. Given the differences in lifestyle, quality, and affordability of health care and the geographical variation in patterns of antibiotic resistance, this study will contribute significantly to providing incentive for routine screening and prophylaxis for S. aureus including methicillin resistant S. aureus colonization in the South Asian population. REGISTERED REPORT IDENTIFIER RR1-10.2196/10219

Impact of an Automated Surveillance to Detect Surgical-Site Infections in Patients Undergoing Total Hip and Knee Arthroplasty in Brazil

2016 ◽  
Vol 37 (8) ◽  
pp. 991-993 ◽  
Author(s):  
Luciana B. Perdiz ◽  
Deborah S. Yokoe ◽  
Guilherme H. Furtado ◽  
Eduardo A. S. Medeiros
Keyword(s):  
Retrospective Study ◽  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Surgical Site Infections ◽  
Infect Control Hosp ◽  
Site Infection ◽  
Total Hip ◽  
Routine Surveillance ◽  
Hip And Knee Arthroplasty ◽  
Automated Surveillance

In this retrospective study, we compared automated surveillance with conventional surveillance to detect surgical site infection after primary total hip or knee arthroplasty. Automated surveillance demonstrated better efficacy than routine surveillance in SSI diagnosis, sensitivity, and predictive negative value in hip and knee arthroplasty.Infect Control Hosp Epidemiol 2016;37:991–993

scholarly journals The projected burden of complex surgical site infections following hip and knee arthroplasties in adults in the United States, 2020 through 2030

2018 ◽  
Vol 39 (10) ◽  
pp. 1189-1195 ◽  
Author(s):  
Hannah M. Wolford ◽  
Kelly M. Hatfield ◽  
Prabasaj Paul ◽  
Sarah H. Yi ◽  
Rachel B. Slayton
Keyword(s):  
Knee Arthroplasty ◽  
Revision Arthroplasty ◽  
Surgical Site Infections ◽  
Population Data ◽  
The United States ◽  
Prevention Measures ◽  
Primary Arthroplasty ◽  
The Us ◽  
Hip And Knee Arthroplasty ◽  
Total Burden

AbstractBackgroundAs the US population ages, the number of hip and knee arthroplasties is expected to increase. Because surgical site infections (SSIs) following these procedures contribute substantial morbidity, mortality, and costs, we projected SSIs expected to occur from 2020 through 2030.MethodsWe used a stochastic Poisson process to project the number of primary and revision arthroplasties and SSIs. Primary arthroplasty rates were calculated using annual estimates of hip and knee arthroplasty stratified by age and gender from the 2012–2014 Nationwide Inpatient Sample and standardized by census population data. Revision rates, dependent on time from primary procedure, were obtained from published literature and were uniformly applied for all ages and genders. Stratified complex SSI rates for arthroplasties were obtained from 2012–2015 National Healthcare Safety Network data. To evaluate the possible impact of prevention measures, we recalculated the projections with an SSI rate reduced by 30%, the national target established by the US Department of Health and Human Services (HHS).ResultsWithout a reduction in SSI rates, we projected an increase in complex SSIs following hip and knee arthroplasty of 14% between 2020 and 2030. We projected a total burden of 77,653 SSIs; however, meeting the 30% rate reduction could prevent 23,297 of these SSIs.ConclusionsGiven current SSI rates, we project that complex SSI burden for primary and revision arthroplasty may increase due to an aging population. Reducing the SSI rate to the national HHS target could prevent 23,000 SSIs and reduce subsequent morbidity, mortality, and Medicare costs.

Application of Hazard Analysis Critical Control Points to Control Surgical Site Infections in Hip and Knee Arthroplasty

Orthopedics ◽  
2008 ◽  
Vol 31 (2) ◽  
pp. 1-5 ◽  
Author(s):  
R. Quattrin ◽  
S. Brusaferro ◽  
D. Turello ◽  
A. Faruzzo ◽  
L. Calligaris ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Hazard Analysis ◽  
Surgical Site Infections ◽  
Control Points ◽  
Critical Control Points ◽  
Hip And Knee Arthroplasty
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