Page 136 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F4.2 Clinical Safety and Quality Services II 16:15 Room 421

The Application of Evidence Based Bundle Approach to Reduce Surgical Site Infection in Geriatric Hip Fracture
Patients – A Single Centre Experience
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Chan PHA , Chu WSV , Hung KYR , Chow CYV , Yuen FYF , Kwok KBC , Hung YW , Fan CHJ , Ho PC 1
1 Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Infection Control Nurse, Alice Ho
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Miu Ling Nethersole Hospital, Department of Microbiology, Prince of Wales Hospital, Department of Anaesthesiology and
Operating Services, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
Introduction
Surgical site infection (SSI) is the third most commonly reported nosocomial infection, increasing morbidities, mortalities
and length of hospital stay. SSI is increasingly seen as a performance indicator of quality of healthcare. In 2010 and 2012, we
experienced an unexpectedly high rate of SSI in geriatric hip fracture with hemiarthroplasty operations done.
Objective
Since 2012, we investigated into the causes and developed a bundle approach to reduce SSI.
Methodology
Monday, 7 May 2018 with chlorhexidine lotion was taken. Peri-operative procedure included set-up of internal guideline, standardised prophylactic
All conservative geriatric hip fracture with hemiarthroplasty from 2008 to third quarter of 2017 were reviewed. Since 2012, pre-
operative MRSA screening was implemented. Vancomycin was given as prophylactic antibiotic for positive screening results
that were available within three days. Pre-operative skin care by bathing one day before operation or on the operation day
antibiotic administration, continuing education of staff, limitation of traffic in operating room, standardisation of disinfection
of surgical site: we have a stringent first stage povidine iodine disinfection, second stage water-proof extremity draping and
sterile plastic sheet wrapping of non-surgical region, third stage ChloraPrep (Chlorhexidine gluconate and isopropyl alcohol)
and followed by circumferential iodophor impregnated plastic adhesive drape (“Ioban”) covering the hip and thigh region. The
surgical wound was dressed with aquacel adhesive tape after wound closure.

Results
A total of 496 hip fracture hemiarthroplasties have been performed over the 10-year period. The mean number of days
between admission and operation was seven days, while length of hospital stay was 20 days. All patients involved in the SSIs
had multiple comorbidities, with diabetes mellitus and hypertension being most prevalent.

The average yearly SSI from 2008 to 2012 was 3.31% for superficial infection, 3.95% for deep infection and overall infection
rate 7.25%. The SSI rate showed significant improvement after bundle approach implementation from 2013 up to third
quarter of 2017, 1.95% for superficial infection, 1.60% for deep infection and overall 3.55%. 57.1% of all the SSIs were
caused by staphylococcus aureus, followed by Pseudomonas species. 79% of all superficial infection cases were treated
with intravenous antibiotic alone according to sensitivity, while 21% required surgical debridement. All deep wound infection
cases (12) required removal of implant and surgical debridements.

The bundle approach has shown to achieve an effective and sustained decrease in SSIs for geriatric hip fracture patients.

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