Multifaceted aseptic protocol decreases surgical site infections following hip arthroplasty. Issue 2 (March 2018)

• Record Type: Journal Article
• Authors: Harold, Ryan E.; Butler, Bennet A.; Lamplot, Joseph; Luu, Hue H.; Lawton, Cort D.; Manning, David
• Is Part Of: Hip international. Volume 28:Issue 2(2018)
• Page Start: 182
• Page End: 188
• Publication Date: 2018-03
• Subjects: Antibiotic prophylaxis -- Aseptic protocol -- Hip arthroplasty -- Surgical site infection; Hip joint -- Pathophysiology -- Periodicals; Hip joint -- Diseases -- Periodicals; Hip joint -- Surgery -- Periodicals; 617.581005
• DOI: 10.5301/hipint.5000551
• Languages: English
• ISSNs: 1120-7000

Abstract

Introduction: We investigate the effectiveness of a comprehensive aseptic protocol in reducing surgical site infection (SSI) after hip arthroplasty in a single medical centre with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Methods: A prospectively collected database of all patients undergoing hip arthroplasty in a single centre between 2005 and 2011 was reviewed for SSI using Centers for Disease Control (CDC) criteria and AAOS guidelines. All patients were administered an aseptic protocol consisting of: preoperative 2% mupirocin nasal ointment and 0.4% chlorhexidine surgical-site wipes; modified instrument care; perioperative prophylactic vancomycin and cefazolin; and surgical-site skin preparation with chlorhexidine, alcohol and iodophor. We compare our protocol hip arthroplasty SSI rate to our institutional historical control and to contemporary literature. Results: Among 774 patients, 69% were ASA>2, 45% had BMI≥30 and 10.3% had rheumatoid arthritis. We found an overall 0.39% infection rate; significantly lower than our institutional historical control (0.39% vs. 2.60%, p<0.001, OR 0.15, NNT 200) and significantly lower than 6 published reports (p<0.001-0.022, OR 0.16-0.22). Compared to these cohorts, significantly more of our patients were ASA>2, had BMI≥30 or had rheumatoid arthritis. Patients with 3 or more identifiable risk factors were at an increased risk of SSI compared to those with 2 or fewer risk factors. Conclusions: Our aseptic protocol decreases SSI in a high-risk population undergoing hip arthroplasty in a medical centre and community with a high prevalence of MRSA.