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A patient laying in a hospital bed with bandaids on his knew covering his surgical site.
Reducing Surgical Site Infections



Surgical site infections (SSI) in the United States are the leading cause of morbidity and mortality among all hospital-acquired infections, and they also are among the most preventable healthcare-associated infections. As such, decreasing SSI has become a priority for orthopedic surgeons around the nation. SSIs are reportable events and tracked by the health network. In 2014 after noting a rise in SSI throughout a health network (2.8% compared to the statewide average of 0.82–0.89%), the staff at one hospital established a Surgical Unit Safety Practice (SUSP) committee to address the issue. The multidisciplinary team was tasked with reviewing all processes and procedures around total joint replacement surgery, from patient consultation through rehabilitation. Of particular concern was the timing of administering antibiotics before and after surgery.

The SUSP team used gap analysis and tracers to identify ways to reduce SSI in total hip and knee arthroplasty. In January 2015, they introduced a standardized care bundle to monitor antibiotic compliance and documentation, which includes a checklist that follows the patient from the orthopedic surgeon's office through discharge. The staff was required to sign their initials on this bundle tag beside the tasks for which their department was responsible as they were completed.

The whole staff embraced the new tool, collaborating with the SUSP team to implement it and help refine and improve the process. The impact on patient safety and outcomes was immediate and dramatic. SSI associated with hip and knee arthroplasty fell to 1.2% in 2015, less than 1% in 2016, and 0% in the first quarter of 2017. Following this success, the team has been expanding the tool to other surgical procedures.

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