Decreasing Orthopaedic Surgical Site Infections: A New Perioperative Protocol.

Background: Little data exist regarding the effects of prophylactic perioperative protocol on reducing surgical site infections. Based on national efforts to prevent SSIs and current evidence in the literature supporting the importance of perioperative prophylaxis, it would seem logical that expanding upon current perioperative protocol would help prevent SSIs.

Hypothesis: Multiple variables present risk factors in the development of SSIs in the perioperative period, and optimization of patient management during this time with a series of non-invasive and inexpensive protocols may help prevent SSIs.

Methods: A six-step perioperative protocol was developed and instituted in our community hospital performing mostly outpatient orthopaedic surgical procedures. The rates of SSIs, diagnosed clinically according to the Center of Disease Control SSI criteria by two orthopaedic surgeons performing the operations during postoperative visits, were recorded in all patients whose index procedure fell within a two-month period before and after the introduction of our protocol. Proportions of infections were compared using Pearson's x2 test.

Results: There were a total of 312 cases performed by two surgeons; evaluated two months before, 153, and two months after, 159, the implementation of our protocol. The incidence of SSIs before initiation of the protocol was 9.1% n=14; and after implementation, the incidence was zero 14 vs. 0, p less than 0.0001.

Conclusion: Multiple variables in the perioperative period can contribute to the incidence of SSIs and can be controlled with diligent attention to prophylactic measures such as those presented in this paper. Our new perioperative protocol represents a cost-effective, and noninvasive method to prevent SSIs in an orthopaedic practice.