6
Time Line of Events
Memo sent to orthopedic surgeons recommending chlorhexadine 4%/isopropyl alcohol as skin prep of choice
Teleconference – Multifactorial Interventions to Prevent Surgical Site Infections
➢ Employ chlorhexadine 4% / isopropyl alcohol as skin prep
➢ Use clippers for hair removal
➢ Maintain a core body temperature of > 36ºc throughout surgery
➢ Administer oxygen at 80% / 50% intra-operatively and at 80% by sealed mask/conventional non-rebreather mask for first two hours of recovery
(? Infe ction)
3
Trending of Hip Prosthesis Infection Rates
7 6 5 4 3 2 1 0
1999
Hip Prosthesis Risk 0 Hip Prosthesis Risk 1 Linear (Hip Prosthesis Risk 0) Linear (Hip Prosthesis Risk 1)
03/06/02
01/28/02
7
Time Line of Events
Meeting with Hospital CEO and key players regarding ortho infections
ቤተ መጻሕፍቲ ባይዱ
Hospital Epidemiologist presents recommendations at Ortho Q.A. Meeting
05/09/02 05/02/02
Orthopedic surgical infections report presented to Infection Control Committee
04/15/02
Infection Control Nurse and Hospital Epidemiologist meet with orthopedic surgeons regarding ortho infections in 2001
05/16/02
Meeting with key players regarding surgical wound infections
Infection Control Nurse and Hospital Epidemiologist perform and videotape a surgical scrub using chlorhexadine 4%/isopropyl alcohol
Surgical Site Infection Collaborative
1
January 1 – September 2, 2001
➢13 orthopedic surgeons involved in 36 musculoskeletal cases that developed infections
09/30/02
Members to discuss ortho surgical
wound infections
Orthopedic infections on Ortho
09/16/02
Dept. Meeting agenda,
discussion deferred
06/24/02
8
9
Recommendations
1
06/17/02 06/18/02 Total Hip Total Hip
1
06/19/02 Total Kne e
4
06/23/02 Total Kne e
9
07/02/02 Total Kne e
16
07/18/02 09/13/02 Total Total Knee Knee
10/25/02 12/25/02 Total Hip Total Hip
2
#of Days Between Total Joint Replacement Infections
January 1, 2002 through June 2003
100 90 80 70 60 50 40 30 20 10 0
87
57
60
42
23
0
02/28/02
Total Hip
03/22/02 Total Kne e
Discussion regarding ortho surgical infections deferred at Ortho Dept. Meeting
12/30/02 12/16/02
Meeting with key players to discuss ortho surgical wound infections
2000
2001
NNIS Risk 1
NNIS Risk 0
2002
4
Trending of Knee Prosthesis Infection Rates
10 9 8 7 6 5 4 3 2 1 0
1999
Total Knee Risk 0 Total Knee Risk 1 Linear (Total Knee Risk 1) Linear (Total Knee Risk 0)
10/28/02
Ortho surgeon addressed the issue of ortho infections briefly at department meeting
10/17/02
Infection Control Nurse and Hospital Epidemiologist meet with Board
2000
2001
NNIS Risk 2 NNIS Risk 1
2002
5
Surveillance Focus Included
➢ASA score ➢Length of surgery ➢Number of personnel in OR suite ➢Microorganism cultured ➢Timing of preoperative antibiotic