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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 6 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. 7