Evaluation of the effect of comprehensive intervention measures on surgical site infection after hip and knee arthroplasty_West China Medical Journal

Authors：

YANG Jiao ¹ , SHI Shuyan ² ,  HUANG Qiang ³

1. Infection Control Department, Chengdu Fifth People’s Hospital, Chengdu, Sichuan 611730, P. R. China;
2. Disciplinary Management Office, Chengdu Fifth People’s Hospital, Chengdu, Sichuan 611730, P. R. China;
3. Orthopedics Department, Chengdu Fifth People’s Hospital, Chengdu, Sichuan 611730, P. R. China;

Corresponding?author：

HUANG Qiang, Email: huangqiang8111@163.com

Keywords：

Chlorhexidine; Intraoperative body temperature maintenance; Health education; Hip arthroplasty; Knee arthroplasty; Surgical site infection

DOI：

10.7507/1002-0179.201912136

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Objective To investigate the impact of comprehensive interventions on the prevention of the incidence of surgical site infection (SSI) after hip or knee arthroplasty.Methods Patients who underwent total hip and knee arthroplasty for the first time in orthopedics department of Chengdu Fifth People’s Hospital from January 2016 to March 2018 were selected. The patients were observed after surgery for 1 year, and divided into the control group and the treatment group according to the odd or even hospitalization number. Basic precautions were taken in the control group, while further comprehensive preventive measures (preoperative chlorhexidine bath, intraoperative body temperature maintenance, using antibacterial film over surgery area without shearing, health and education after discharge from hospital) were taken in the treatment group. The incidence of SSI of the two groups was compared to evaluate the effects of comprehensive interventions.Results A total of 341 patients were included, including 174 in the control group and 167 in the treatment group. No one failed to be followed up. Among the 341 patients undergoing surgery, 13 had SSI, including 11 (6.3%) in the control group and 2 (1.2%) in the treatment group. The incidence of SSI in the treatment group was lower than that in the control group (χ²=6.102, P=0.014). Single factor analysis showed that sex (χ²=10.933, P=0.001), preoperative chlorhexidine sponge bath (χ²=8.837, P=0.003), intraoperative thermal insulation (χ²=13.917, P<0.001), health education (χ²=12.671, P<0.001), skin preparation methods (χ²=6.102, P=0.014), perioperative blood glucose control (χ²=17.512, P=0.003), and surgical type (χ²=8.360,factor P=0.004) were the effect factors of occurrence of SSI. Logistic regression analysis showed that surgical type [odds ratio (OR)=0.129, 95% confidence interval (CI)(0.026, 0.640), P=0.012] and strict blood glucose control [OR=9.868, 95%CI (2.158, 45.131), P=0.003] were the independent factors affecting the occurrence of SSI.Conclusions Comprehensive intervention measures can effectively reduce the occurrence of SSI after hip and knee arthroplasty. It is not confirmed that preoperative chlorhexidine bath can reduce the occurrence of SSI. But choosing selective operation and controlling the perioperative blood glucose below 200 mg/dL can reduce the risk of SSI.

Citation： YANG Jiao, SHI Shuyan, HUANG Qiang. Evaluation of the effect of comprehensive intervention measures on surgical site infection after hip and knee arthroplasty. West China Medical Journal, 2020, 35(3): 307-311. doi: 10.7507/1002-0179.201912136 Copy

1.	Ramírez-Wong FM, Atencio-Espinoza T, Rosenthal VD, et al. Surgical site infection rates in more than 13,000 surgical procedures in three cities in peru: finding of the international nosocomial infection control consortium. Surg Infect (Larchmt), 2015, 16(5): 572-576.
2.	Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
3.	Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg, 2017, 152(8): 784-791.
4.	葛茂軍. 關節假體感染的預防. 華西醫學, 2019, 34(3): 243-250.
5.	Evans HL, Dellit TH, Chan J, et al. Effect of chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg, 2010, 145(3): 240-246.
6.	Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Ann Surg, 2011, 253(6): 1082-1093.
7.	侯玉娟, 陸娟, 楊太明, 等. 含碘手術膜在植入物手術中的效果研究. 中華醫院感染學雜志, 2011, 21(16): 3425.
8.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
9.	中華人民共和國衛生部. 中華人民共和國衛生行業標準 WS/T312 2009: 醫院感染監測規范. 中華醫院感染學雜志, 2009, 19(11): Ⅰ-Ⅱ.
10.	杜鵬, 董亭月. 促進健康老齡化: 理念變革與政策創新—對世界衛生組織《關于老齡化與健康的全球報告》的解讀. 老齡科學研究, 2015, 3(12): 3-10.
11.	趙明明, 任磊, 劉衛兵, 等. 人工關節置換術切口感染因素調查. 中國消毒學雜志, 2014, 31(12): 1339-1340.
12.	吳建濃, 干鐵兒, 周亞芬, 等. 人工關節置換術患者術后醫院感染危險因素分析. 中華醫院感染學雜志, 2014, 24(21): 5357-5359.
13.	Edmiston CE Jr, Krepel CJ, Seabrook GR, et al. Preo Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission?. J Am Coll Surg, 2008, 207(2): 233-239.
14.	Seal LA, Paul-Cheadle D. A systems approach to preoperative sursical patient skin preparation. Am J Infect Control, 2004, 32(2): 57-62.
15.	張曉文. 改進術前皮膚準備對全髖關節置換術病人手術切口感染的影響. 中國醫刊, 2010, 45(11): 45-47.
16.	Chlebicki MP, Safdar N, O’Horo JC, et al. Preoperative chlorhexidine shower or bath for prevention of surgical site infection: a meta-analysis. Am J Infect Control, 2013, 41(2): 167-173.
17.	武喜紅, 馬瑾, 王濤. 主動保溫干預措施預防全身麻醉患者術中低體溫的效果. 中國當代醫藥, 2019, 26(30): 250-252.
18.	馬麗莉. 多模式保溫對老年骨科患者術中低體溫發生率的影響. 首都食品與醫藥, 2019, 26(15): 161.
19.	Mraovic B, Suh D, Jacovides C, et al. Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty. J Diabetes Sci Technol, 2011, 5(2): 412-418.

1. Ramírez-Wong FM, Atencio-Espinoza T, Rosenthal VD, et al. Surgical site infection rates in more than 13,000 surgical procedures in three cities in peru: finding of the international nosocomial infection control consortium. Surg Infect (Larchmt), 2015, 16(5): 572-576.
2. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
3. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg, 2017, 152(8): 784-791.
4. 葛茂軍. 關節假體感染的預防. 華西醫學, 2019, 34(3): 243-250.
5. Evans HL, Dellit TH, Chan J, et al. Effect of chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg, 2010, 145(3): 240-246.
6. Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Ann Surg, 2011, 253(6): 1082-1093.
7. 侯玉娟, 陸娟, 楊太明, 等. 含碘手術膜在植入物手術中的效果研究. 中華醫院感染學雜志, 2011, 21(16): 3425.
8. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
9. 中華人民共和國衛生部. 中華人民共和國衛生行業標準 WS/T312 2009: 醫院感染監測規范. 中華醫院感染學雜志, 2009, 19(11): Ⅰ-Ⅱ.
10. 杜鵬, 董亭月. 促進健康老齡化: 理念變革與政策創新—對世界衛生組織《關于老齡化與健康的全球報告》的解讀. 老齡科學研究, 2015, 3(12): 3-10.
11. 趙明明, 任磊, 劉衛兵, 等. 人工關節置換術切口感染因素調查. 中國消毒學雜志, 2014, 31(12): 1339-1340.
12. 吳建濃, 干鐵兒, 周亞芬, 等. 人工關節置換術患者術后醫院感染危險因素分析. 中華醫院感染學雜志, 2014, 24(21): 5357-5359.
13. Edmiston CE Jr, Krepel CJ, Seabrook GR, et al. Preo Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission?. J Am Coll Surg, 2008, 207(2): 233-239.
14. Seal LA, Paul-Cheadle D. A systems approach to preoperative sursical patient skin preparation. Am J Infect Control, 2004, 32(2): 57-62.
15. 張曉文. 改進術前皮膚準備對全髖關節置換術病人手術切口感染的影響. 中國醫刊, 2010, 45(11): 45-47.
16. Chlebicki MP, Safdar N, O’Horo JC, et al. Preoperative chlorhexidine shower or bath for prevention of surgical site infection: a meta-analysis. Am J Infect Control, 2013, 41(2): 167-173.
17. 武喜紅, 馬瑾, 王濤. 主動保溫干預措施預防全身麻醉患者術中低體溫的效果. 中國當代醫藥, 2019, 26(30): 250-252.
18. 馬麗莉. 多模式保溫對老年骨科患者術中低體溫發生率的影響. 首都食品與醫藥, 2019, 26(15): 161.
19. Mraovic B, Suh D, Jacovides C, et al. Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty. J Diabetes Sci Technol, 2011, 5(2): 412-418.

West China Medical Journal

Evaluation of the effect of comprehensive intervention measures on surgical site infection after hip and knee arthroplasty

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