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HSO Leading Practices Library

Best Practice in Infection Prevention and Control in a Surgical Patient Population (2013) https://healthstandards.org/leading-practice/best-practice-in-infection-prevention-and-control-in-a-surgical-patient-population/ (Health Standards Organization, 2013)

Healthcare associated infections are considered a serious threat to the hospitalized patient's safety. Among surgical site infections, those related to orthopaedic procedures are considered severe and can increase morbidity-mortality rates. Factors in the preoperative, intraoperative, and postoperative periods that can help prevent orthopaedic infections include good preoperative skin care, optimal care during the operative phase, high rates of hand hygiene compliance throughout the continuum of care, stringent aseptic technique with postoperative dressing changes and the reduction of any incision site complications such as blisters. In the pre-operative period, the goal is effective skin preparation to reduce the resident microbial count and is achieved by having patients shower using Chlorhexidine 2 per cent, eliminating shaving, and screening for antibiotic resistant organisms such as MRSA. In the operative phase, the administration and timing of prophylactic antibiotics are crucial to the reduction of infection rates. Timing was improved by having Nurses start the infusion when the previous patient leaves the OR. The dose of the antibiotic Ancef was increased from 1 to 2 gms, and antibiotic impregnated cement (methyl methacrylate) was introduced. Perioperative normothermia has been shown to help decrease infections in orthopaedic patients so all patients are provided with warming blankets. Hand Hygiene is considered the single most important way to reduce nosocomial infections. Holland Centre compliances rates went from 28 per cent in 2008 to 85 per cent in 2012 with education, increased access to hand wash stations and products at Point-of-Care. We also now have full compliance with staff not wearing hand or arm jewelry and not eating and drinking in the nursing stations. These two factors are known to decrease infection rates. The introduction of a new wound care product and protocol, reduced the need for dressing changes, allowed greater flexibility for patients mobilizing and showering after surgery, and reduced blistering around the wound. The Holland Centre performs over 2,100 Total Joint procedures annually. A comprehensive process is in place to monitor and report infection rates for 12 months following surgery. In 2011/12 surgical infection rate in total hip and knee replacement patients was 0.00 per cent (compared to the National Healthcare Safety Network (NHSN) target rates of 0.75 per cent for hips and 0.68 per cent for knees). Preliminary data for 2012/13 shows that the program has sustained a 0.00 per cent infection rate for both hip and knee patients. We continually strive to improve practice throughout the entire process in order to eliminate surgical site infections in our patient population.