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How to reduce infection rate in primary hip and knee replacement surgery

Piteå Älvdals Hospital

Sweden

Problem Goals

Infection after surgery places demands on medical resources and is expensive as well as causing suffering for the patient

To reduce the frequency of deep infections after primary hip and knee replacements to <0,5 % and superficial infections to < 5 %

Changes in nursing care:

Basic hygiene rules Basic clothing rules For work with

patients, protective coats of cloth were exchanged for plastic aprons

More automatic hand alcohol cleansing units installed

Purchase of UV lamp to check effect of alcohol cleansing

Check that the patients have been showered twice with Descutan before operation

All staff were given regular information and training in hygiene and dressing

Measurement follow-ups were regularly reported

Clock on the wall

Tougher clothing rules for

anaesthesia personal

Surgical caps and masks

20-second rule

One sterile package instead of 35

Iodine drape over the operation site

Post operation : Wound dressing with

8 layers of Aquacel on primary hip replacement

Aquacel Ag for risk category patients: insulin treated diabetics, RA patients treated with immunosuppressive drugs, ASA over 3, psoriasis and other skin diseases

Training of all staff in sterile dressing techniques

Basic hygiene rules Basic clothing rules Patient-specific

mobile baskets for bedclothes

Measurement

0%1%2%3%4%5%6%7%8%9%

10%

2005 2006

Deepinfection

Superficialinfection

0%10%20%30%40%50%60%70%80%90%

100%

2005 2006

Hygiencompliance

Clothingcompliance

Every person who meets the patient must be educated and apply the new hygiene routines Regular measurement of

compliance with basic hygiene and clothing rules

The changes were implemented through the provision of information, oral and written, and regular training sessions

All staff around the patient are involved in the improvment process

There was moderate resistance to the changes, but information and encouragement have enabled us to solve the problems and achieve positive results

Occurrence of deep and superficial infections were measured by contacting all patients after four weeks and checking the journal after four months