Department of Trauma and Orthopaedic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
Surg Infect (Larchmt). 2024 Oct;25(8):574-579. doi: 10.1089/sur.2024.019. Epub 2024 Jul 3.
Hip fractures are the most common serious injury in the elderly, associated with disability, morbidity, and mortality. Surgical site infection (SSI) is a serious post-operative complication. This prospective cohort study outlines how our center made cumulative improvements in SSI incidence rates, reaching a 12-month average of 0.5%. All patients undergoing hip fracture operation between 2016 and 2021 were included. The primary outcome measure was confirmed SSI, according to the Public Health England definition. Results were compared with the baseline recordings by an independent SSI team in 2013. Demographic data were compared with National Hip Fracture Database records. Peri-operative infection control and wound management tactics introduced between 2014 and 2021 were collated to gain an overview care bundle. Baseline recordings identified a 9.0% SSI rate in a three-month observation period. In our study, 3,138 hip fracture operative cases were completed between October 2016 and December 2021. There were 9 superficial and 32 deep infections identified, yielding an overall infection rate of 1.3%. However, when analyzing the 12-month average, there was consistent decline in SSI from the baseline 9.0% in 2013 to 0.5% in 2021 (p < 0.05). A peri-operative care bundle included pre-operative bleeding risk assessment. Intra-operatively, double preparation and draping is used for arthroplasty. Broad-spectrum antibiotic agents and tranexamic acid are administered. Meticulous hemostasis and watertight wound closure are observed. Anti-coagulated patients received negative pressure dressings. Post-operatively, a dedicated senior lead team provided daily inpatient review of patients, with urgent consultant review of all wound healing concerns. Patients with a hip fracture have numerous risk factors for SSI. A dedicated multi-focal tactic, adopted by a multi-disciplinary department, can yield substantial risk reduction. Each intervention is evidence based and contributes to cumulative improvement. By prioritizing infection prevention, we have minimized the need for complex infection management interventions and achieved an annual saving of £860,000 for our trust.
髋部骨折是老年人最常见的严重损伤，与残疾、发病率和死亡率有关。手术部位感染（SSI）是一种严重的术后并发症。本前瞻性队列研究概述了我们中心如何逐步降低 SSI 发生率，达到 12 个月平均 0.5%的水平。所有 2016 年至 2021 年间接受髋部骨折手术的患者均纳入研究。主要结局测量指标为根据英国公共卫生署的定义确诊的 SSI。结果与 2013 年由独立 SSI 小组进行的基线记录进行了比较。人口统计学数据与国家髋部骨折数据库记录进行了比较。2014 年至 2021 年间引入的围手术期感染控制和伤口管理策略被整理以获得全面的护理包概述。基线记录显示，在三个月的观察期内 SSI 发生率为 9.0%。在我们的研究中，2016 年 10 月至 2021 年 12 月期间完成了 3138 例髋部骨折手术。发现 9 例浅表感染和 32 例深部感染，总感染率为 1.3%。然而，当分析 12 个月的平均值时，SSI 从 2013 年的基线 9.0%持续下降到 2021 年的 0.5%（p<0.05）。围手术期护理包包括术前出血风险评估。术中，关节置换术采用双重准备和铺单。给予广谱抗生素和氨甲环酸。仔细止血和水密性伤口闭合。接受抗凝治疗的患者使用负压敷料。术后，由一名资深领导团队每天对住院患者进行查房，所有伤口愈合问题均由顾问紧急会诊。髋部骨折患者有许多 SSI 的危险因素。多学科部门采用的有针对性的多焦点策略可以显著降低风险。每个干预措施都有证据支持，并有助于累积改善。通过优先考虑感染预防，我们最大限度地减少了复杂感染管理干预的需要，并为我们的信托基金节省了每年 86 万英镑。
