Effect of surveillance on surgical site infection rate in knee and hip arthroplasty

Objective. To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. Material and methods. Prospective surveillance in two time periods in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between them adherence to recommendations was reinforced. Main results. A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32.7% in the last year (p < 0,001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, the NNIS index-risk 2 being more frequent in period A (16.8%) than in period B (5.4%) (p<0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (COPD) (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. Conclusions. Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial.