The effect of care bundle development on surgical site infection after hemiarthroplasty: An 8-year review

BACKGROUND: Proximal femoral fracture is the most common reason for emergency orthopedic admission in the United Kingdom with an annual cost of 1.7 pound billion to the National Health Service. Surgical site infection (SSI) after proximal femoral fracture increases patient morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) poses a particular risk in this patient cohort as a large proportion of these patients are residents of long-term care facilities and are therefore transient or chronic carriers of MRSA. We recorded the effect of three stages of care bundle development on the infection and specifically the MRSA rate after hemiarthroplasty over an 8-year period. METHODS: Data were collated retrospectively from the surgical site infection surveillance service. These data were prospectively collected and independently collated. The data were analyzed using the chi(2) test and the normal test for differences between two proportions. RESULTS: Between October 2001 and June 2009, 1,830 hemiarthroplasties were performed. A statistically significant difference (p < 0.05) in SSI and MRSA rate was identified. The most effective care bundle included double skin preparation using alcoholic chlorhexidine, a single dose of intravenous co-amoxiclav (1.2 g) and gentamicin (240 mg) at induction, and implanted gentamicin-impregnated equine collagen at wound closure. CONCLUSIONS: Adoption of our care bundle approach led to a reduction in SSI rate after hemiarthroplasty. The care bundle we propose is tailored to reduce MRSA infection and minimize risks associated with antibiotic prophylaxis. It is a simple and cost-effective improvement in the clinical care of this vulnerable group. (J Trauma. 2012;72: 1375-1379. Copyright (C) 2012 by Lippincott Williams & Wilkins)