Download Multidisciplinary Team Working Toward Zero Orthopedic

Poster No. 5
Title:
Multidisciplinary Team Working Toward Zero Orthopedic Surgical Infections
Authors:
Maureen Spencer, Susan Davidson, Diane Gulczynski, Susan Cohen, Stephen Parazin, John Richmond
Presented by:
Maureen Spencer
Departments:
Infection Control Unit, Department of Infectious Disease, Department of Patient Care Services, Department of
Orthopedics and Rehabilitative Services, New England Baptist Hospital
Abstract:
Introduction: A multidisciplinary team was formed to address an increase in the infection rate in FY03 and
implement control measures in an orthopedic specialty hospital.
Objective:

Administration established intent for zero tolerance for surgical site infections.

The formation of a multidisciplinary task force was established to identify problems and implement
corrective action plans and infection prevention measures.
Methods: The team included representatives from OR nursing, orthopedic surgeons, anesthesia and managers
from infection control health care quality, central supply, facilities and environmental services. The team
evaluated operating room procedures, practices and facility design and prioritized action plans to institute
infection control measures. In addition, throughout the 5 year period, reinforcement of hand hygiene was done
with creative and highly visible marketing campaigns for staff and visitors.
The specific Issues evaluated each year included.

2003 - traffic control, surgical attire, surgical hand scrub, environmental disinfection, processing of
surgical instruments, HEPA filtration and laminar flow

2004 - antibiotic surgical prophylaxis and silver impregnated post-op dressings

2005 - use of antibacterial sutures

2006 - prescreening program for MRSA and Staph aureus and decolonization protocol

2007 - elimination of the use of locally administered steroids in laminectomy surgery

2008 - chlorhexidine skin prep and antimicrobial dressings
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Poster No. 5
Results: Orthopedic infections and rates during the 5 year period were as follows:

FY03 - 63 SSI/8837 cases (0.7)

FY04 - 60 SSI/9669 cases (0.6)

FY05 - 49 SSI/9216 cases (0.5)

FY06 - 46 SSI/8986 cases (0.5)

FY07 - 39 SSI/9027 cases (0.4)

FY08 - 37 SSI/8884 cases (0.4)
Standardized infection ratios were calculated each year by risk index and benchmarked against CDC/NNIS data.
These guided the team in risk analysis of the orthopedic population. A 60% decline in MRSA and Staph aureus
infections was observed after the implementation of the MRSA and Staph aureus eradication program.
Laminectomy infection rates decreased from 1.3% to 0.5% after discontinuing the routine use of local steroids.
Conclusion: The importance of a team approach to infection control in the operating room is key to a successful
infection control and prevention program. Integrating infection control into surgical services is an effective way
to foster communication, collaborative work and achieve lower infection rates. We have documented a steady
decline in SSI over a five year period of diligent attention to risk analysis and implementation of effective
prevention measures.
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