Morsi Samar Saeed, Omar Abeer, Hebbar Gautam, Al-Fadhli Mariam, Hamza Wafaa S
PhD, Associate Professor at Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt, Consultant of Infection Control, Al-Razi Orthopedic Hospital, Kuwait, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait.
PhD, Head of Surveillance Department, at Infection Control Directorate, Ministry of Health, Sabah health region, P.O. Box: 12414 Alshamiya, Kuwait.
Germs. 2021 Mar 15;11(1):10-22. doi: 10.18683/germs.2021.1236. eCollection 2021 Mar.
Prevention strategies are critical to reduce infection rates in joint arthroplasty. This study aimed to investigate the effectiveness of a set of evidence-based practices to reduce surgical site infection (SSI) rates after knee and hip arthroplasty (HPRO & KPRO).
A quasi-experimental study design (comparing pre- and post-intervention phases) was applied. Interventions were selected, adapted, and implemented in knee and hip arthroplasty procedures as a prospective practice. They consisted of 13 processes throughout the surgical encounter, including preoperative, intraoperative, and postoperative elements.
Regarding hip arthroplasty procedures, the overall SSI rate during the pre-intervention period was 11.9%, which was reduced significantly to 5.1% (57% reduction) in the intervention period (p=0.042). For knee arthroplasty procedures, the overall baseline SSI rate during the pre-intervention period was 2.7%, which was reduced to 2.0% (26% reduction) in the intervention period. However, this reduction was not statistically significant (p=0.561). Combined methicillin-resistant (MRSA) screening with appropriate decolonization and targeted prophylaxis were associated with a 50% reduction in SSI caused by MRSA in knee arthroplasty.
The implementation of multidimensional evidence-based practices was associated with a reduction in SSI following knee and hip arthroplasties.
预防策略对于降低关节置换术的感染率至关重要。本研究旨在调查一套循证实践措施对降低膝关节和髋关节置换术（HPRO和KPRO）后手术部位感染（SSI）率的有效性。
采用准实验研究设计（比较干预前后阶段）。在膝关节和髋关节置换手术中选择、调整并实施干预措施，作为一项前瞻性实践。这些措施包括手术全过程的13个环节，涵盖术前、术中和术后因素。
对于髋关节置换手术，干预前期的总体SSI率为11.9%，在干预期显著降至5.1%（降低了57%）（p = 0.042）。对于膝关节置换手术，干预前期的总体基线SSI率为2.7%，在干预期降至2.0%（降低了26%）。然而，这一降低无统计学意义（p = 0.561）。在膝关节置换术中，联合耐甲氧西林金黄色葡萄球菌（MRSA）筛查与适当的去定植及靶向预防措施，可使由MRSA引起的SSI降低50%。
实施多维度循证实践措施与膝关节和髋关节置换术后SSI率的降低相关。
