Targeted infection control practices lower the incidence of surgical site infections following total hip and knee arthroplasty in an Indian tertiary hospital

Abstract

Introduction: Deep surgical site infection (SSI) following total knee arthroplasty (TKA) or total hip arthroplasty (THA) is a devastating complication that occurs in approximately 2% of surgical procedures and accounts for 20% of healthcare-associated infections. Despite improvements in prevention, SSI remains a significant clinical problem. Prevention bundles are central to prevent SSI. Methods: SSIs following TKA/THA are defined by centres for disease control and prevention (CDC) as infections occurring within 1 year post-surgery. Targeted surveillance using prevention bundles for SSIs was instituted among cohort of patients with primary hip and knee arthroplasties from January 2014 to September 2016. Secondary data analysis of the follow-up was done during the physiotherapy appointment and surgical site review visits by the infection control professionals. Infection control team instituted policies and capacity building of known risk factors, such as admitting patients only on day of surgery, pre-operative chlorhexidine bath, hair clipping, timing of antibiotic prophylaxis, glycaemic control, use of High-efficiency particulate air (HEPA) filters and reducing operation theatre traffic. We calculated the incidence, trend and post-operative follow-up of SSIs after universal implementation of bundles. Results: Among 9666 patients with TKA or THA over 4 years, 8967 were successfully followed up for 1 year. Of the 8967 arthroplasties, 49 cases had SSIs (0.52%). TKA and THA contributed to 89% (42 of 47) and 11% (5 of 47) of the SSIs, respectively. The characteristics of SSIs were 83%, 15% and 2% superficial, deep and organ, respectively. Over the 4 years, the combined SSIs of TKA and THA decreased from 0.79% to 0.34% and the proportion of lost to follow-up decreased from 11.09% to 3.72%. Cases of SSI had co-morbidities such as hypertension, diabetes and others. Conclusion: Targeted surveillance with adherence to infection control practices significantly reduces the incidence of SSI. Stringent documentation and follow-up of the patients post-surgery will ensure that the SSIs are monitored and attended to.