Archive Orthopedic Surgery 2018

Infection-Free Joint Replacements

7 ways to prevent SSIs from developing in incisions and implants.

Daniel Cook

Daniel Cook, Executive Editor


ON COURSE Administering the right amount of the right antibiotic at the right time is key to preventing infections.

Despite antibiotics and preventive treatments, roughly 1 in 100 patients undergoing hip or knee replacement may develop an infection in the wound or deep around their artificial implants. It's thought that some of the particles above the sterile field are bacteria that contaminate the incision or the metal or plastic implants, reproduce and cause an infection. Patients with infected joint replacements often require surgery to kill the infection.

"You're starting from behind the eight ball when it comes to preventing infections," says Annette Yerkes, BSN, RN, CNOR, a nurse manager at Einstein Medical Center Elkins Park (Pa.), where 5 years ago the infection rate among Einstein's joint replacement patients was 2.8%, more than 3 times as high as facilities across Pennsylvania. A team from the care continuum came together to form the Surgical Unit Safety Program (SUSP), which performed a tracer methodology to assess every patient touch and developed a standardized SSI prevention bundle and a checklist tool called the Travel Tag, which moves with the patient from the surgeon's office through to discharge. Every staff member who cares for patients adds a checkmark to the document to show she's done her part to prevent SSIs.

Since implementing the program in 2015, rates of infection at Einstein steadily declined before bottoming out at zero last year. If Einstein's efforts are any indication, there's likely plenty more you can do to prevent infections in joint replacement patients.

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