Winning the War on Surgical Site Infection: Evidence-Based Preoperative Interventions for Total Joint Arthroplasty

Abstract

Postoperative surgical site infections (SSIs) are the most common cause of expensive and debilitating revision surgeries. The Institute for Healthcare Improvement has introduced a three-intervention package, titled Project JOINTS, which attempts to control preoperative and perioperative factors contributing to postoperative SSI in patients undergoing total joint arthroplasty (TJA). The three interventions are preoperative screening for Staphylococcus aureus, decolonizing the skin and nares, and intraoperative administration of combined antimicrobial and alcohol agents to the skin. Canton-Potsdam Hospital was an early adopter of the Project JOINTS protocol, and this quality improvement project has demonstrated a reduced SSI rate throughout the two years of implementation. Before implementation, 596 TJAs were performed with an S aureus SSI rate of 1.8%. During Project JOINTS, 305 TJAs were conducted with a significantly (P = .050) lower S aureus SSI rate of 0.66%. Thus, Project JOINTS is effective at reducing the postoperative incidence of S aureus SSIs in patients undergoing TJA.