Reducing the Institutional Incidences of Orthopedic Arthroplasty Infections

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Table of Contents

Project Rationale
Personal/Professional Expectations
Project Goals
Procedure
Project Outcomes
References

This project aimed to reduce institutional incidences of orthopedic arthroplasty infections. Orthopedic arthroplasty, also referred to as joint replacement surgery, represents one of the most regularly performed orthopedic surgery procedures (Antonelli & Chen, 2019). As the demand for the procedure grows, the number of related complications increases (Antonelli & Chen, 2019). Specifically, a periprosthetic joint infection (PJI) is one of the most devastating complications resulting from total knee arthroplasty (TKA) (Buchalter et al., 2021). Healthcare professionals utilize several strategies, such as preventative preoperative screening and infection deterrence during and post-surgical intervention.

Thus, the project aimed to discover strategies for reducing arthroplasty-associated infections within the outpatient setting. A complete assessment was conducted to identify any current deficiencies and prior infections after a TKA in the local facility and preoperative and post-surgical processes to prevent infection. The project suggested that combining patient education and preoperative optimization could help decrease the risks of adverse health outcomes. Furthermore, patients’ risk factors were recognized, and strategies to reduce infection instances were discovered. Successful implementation of the suggestions necessitated further education and greater staff involvement. Lastly, the greatest identified challenges to implementation entailed workforce shortage and limited time.

Project Rationale

The rationale for creating this project arose from the experience of working in an outpatient surgical setting operated by private physicians. Invasive surgeries requiring implants, particularly TKAs, demand meticulous attention to detail to prevent surgical site infections and complications. As Buchalter et al. (2021) note, despite the overall low incidence of PJI in the United States, it still accounts for about half of the readmissions for all total joint arthroplasties. Moreover, PJI significantly reduces satisfaction and life expectancy in patients who suffer from it (Buchalter et al., 2021). Therefore, facilities must devote significant resources to preventing, detecting, and treating surgical site infections (SSI) and PJI. Infection prevention, in particular, is essential for a patient’s full recovery, with SSI control and surveillance being the main ways and reducing SSI rates by 40% (Finkelstein et al., 2017). This project investigated suggested ways of infection prevention and preemptive monitoring to improve the local facility’s tactics.

After surgery, the population with a high chance of SSI and PJI share common risk factors. Antonelli and Chen (2019) discussed reducing postoperative complications by involving people in addressing their underlying conditions, the most common ones being diabetes, obesity, anemia, and malnutrition, accounting for 80% of patients at risk. Patients with over one risk factor are most susceptible to the onset and development of PJI (Antonelli & Chen, 2019). Further, elderly patients require a particularly careful examination since they spend a longer time in the hospital post-surgery, resulting in a mortality rate five times higher than in younger patients (Antonelli & Chen, 2019). Therefore, conducting preoperative screening in the local facility is critical for detecting risk factors and appropriately mitigating their impact on postoperative recovery.

The population with mentioned risk factors could benefit significantly from the increased awareness. Screenings should be performed 2-6 weeks before surgery to allow sufficient time for intervention and treatment, for instance, antibiotics administration (Antonelli & Chen, 2019). In-depth training and timely intervention are essential in optimizing patients’ states before the operation. Moreover, patients requiring reoperation also require critical follow-up regardless of screening results before the first operation (Antonelli & Chen, 2019). The project was created to reduce TKA-related infections through patient education, counseling, and follow-up in an outpatient context.

Personal/Professional Expectations

The project was expected to provide practical and theoretical knowledge about reducing infections developing after TKA. Furthermore, the project aimed to provide guidance on preoperative screening for risks of infections and recommend interventions to reduce their occurrence efficiently and cost-effectively. From a personal perspective, working with high-risk patients was necessary to strengthen collaboration and implement more efficient preoperative protocols. The posed expectations regarding the research and guidance suggestions were mostly met. However, implementing the recommendations and conversing directly with patients and staff ascertained being a challenging, team-oriented task.

Project Goals

This project’s overarching goal was to identify PJI risk factors during the surgical process and take steps to ensure infection-preventing policies and procedures are followed. A multi-dimensional approach to project implementation required three sub-goals to achieve this aim. First, educating providers regarding PJI’s risk factors and groups of patients highly likely to develop adverse conditions. The goal was largely achieved by reviewing patient surgical lists and identifying risk factors. Second, facilitating patient education aimed at high-risk individuals who may develop post-TKA infections.

This goal was achieved partially through discussing preoperative patient screenings with surgeons; however, the time spent directly with patients was inadequate. Lastly, improving multidisciplinary collaboration involving patients, surgeons, nurses, and other relevant members of care teams to enhance overall health outcomes. This goal was achieved by reviewing the extant facility policy on infection control and TKA conduct and then further discussing areas of improvement with individual staff members. However, a larger suggested conversation is yet to take place.

Procedure

The first step of the procedure included receiving permission from the nurse administrator for the project implementation. The initial data collection included peer-reviewed scholarly publications obtained through search engines like GALILEO, Google Scholar, and PubMed. The collected information comprised theoretical and evidence-based support of the importance of preventing infection after a TKA. The subsequent data collection entailed reviewing the facility policy regarding infection control and surgery procedures and interviewing the team members. This mode of data collection allowed for a dynamic exchange of information with the surgical team members, aiding the goal of educating providers. The research, including new guidelines and practices, was partially and informally presented to the clinical team for review and feedback.

A baseline of patients that underwent TKA was established, and their records were monitored for the following 12 months to note any complications or SSI. Over 15 TKA surgical cases from both an outpatient center and a hospital were evaluated, providing a basis for future patient education. Overall review of charts, medical orders, and complications was conducted, focusing on pre-existing conditions and their relation to potential post-operational complications.

Concurrently, the actions of the operating room team were observed, and the sequence of events that occurred before, during, and after the surgery was closely studied. Interviews with all staff members, including the surgeons, the anesthesia team, nurses, and sterile processing technicians, were continued. Interviewing process entailed both inquiries on technical specifics and personal opinions and discussion of current and novel practices of post-TKA care. The observations were then compared to the current evidence-based practice to ensure optimal results for TKAs.

Project Outcomes

The project’s expected outcome was improved awareness and preparation of healthcare personnel to identify and assess high-risk patients. A success metric was defined as the implementation of diligent patient screening to identify patient risk factors for PJI. In addition, an increased level of patient education was deemed crucial due to the need to optimize pre-surgery care as the risk factors for infection development can be distinguished. The suggested dialogue with staff members and the suggested future steps are given below.

Because of the seriousness of TKA, voluminous new research has been conducted in the past five years on novel infection prevention strategies. Several explanations contribute to this, including more up-to-date science and the initiation of TKAs in an outpatient setting versus the hospital. Surgical evidence-based practice and clinical research were deemed essential for assessing technical innovations, the efficacy of pharmaceuticals and medical devices, and preventive interventions to provide better patient care (Ali et al., 2021). Some researchers adhere to the same guidelines the local surgeons and facilities follow; however, some innovations remain untested. This project aimed to present the discovered findings from newer research to the local team.

The peer-reviewed articles provided the direction for critically examining the local surgery center, conducting successful interviews with the operating room staff, and designing an effective observation process. This project has stressed that evidence-based practice is essential to conducting daily procedures. Evidence-based practice was observed to be the foundation of health care professional education (Lehane et al., 2019). Another improvement would be to use different postoperative wound dressings, such as antimicrobial types, which provide optimal results in reducing the risk of postoperative complications like infection-inducing blisters (Kuo et al., 2021). Common dressings were compared with those currently used by the local facility, with results and infection occurrence rates investigated thoroughly for making suggestions.

A substantial portion of the project was spent observing surgeries, collecting patient data, and interviewing staff. A review of patient surgical cases was conducted, but not much conclusive data was devised from the evaluation. However, the observation in the operating room and the interviews with surgeons were exceptionally insightful. A considerable time was spent discussing surgeons’ opinions on the following: crucial aspects of surgeries, potential facility improvements, and the consequences of technological advancements in orthopedic medicine.

While the assessment and research on the topic were partially done through this report, the initiation and follow-through will require the involvement of the entire clinical team to be successful. The availability and knowledge of the existing evidence-based practice regarding total joint surgery were deemed insufficient. The medical personnel, such as nurses and scrub technicians, currently possess limited capacity to retrieve pertinent scholarly publications. This project discovered the need to create a research-and-review routine for the local staff. Therefore, an in-service with the clinical team was suggested for the future, where potential improvements in the local facility’s infection prevention strategies could be discussed.

Another personnel skills training would be getting local surgeons involved in the dialogue with the operating support team. Reviewing the literature highlighted the importance of a meticulous and multi-modal approach in orthopedic arthroplasty surgeries. Minor changes can be crucial for ensuring a successful reduction in SSI. However, this study found some obstacles, the biggest ones being lack of time and deficient staffing. Current nursing shortages are among the largest causes of concern with implementing suggested changes since adding supplementary tasks to current workloads will further burden the already overwhelmed staff.

To conclude, although this project was not as interactive as initially planned, it nonetheless amassed several valuable insights and potential policy and operations suggestions. The patient interviews were partially replaced with reviewing the surgery reports and scholarly literature. The material for the surgical team meeting to educate staff on novel practices was prepared, but the meeting has not been conducted yet. Risk factors were successfully identified, and steps to ensure effective infection-preventing procedures were suggested based on the new research and insights from interviews. Therefore, the overarching goal of this project has been achieved. However, further education and larger involvement of staff members are crucial to successfully implementing the suggested policies.

References

Ali, T., Al Shakarchi, J., Dewan, V., & Hussain, K. (2021). The importance of evidence-based surgery, surgical protocols and research methodologies. Journal of Surgical Protocols and Research Methodologies, 2021(1), 1-2. Web.

Antonelli, B., & Chen, A. F. (2019). Reducing the risk of infection after total joint arthroplasty: Preoperative optimization. Arthroplasty, 1(1), 1-13. Web.

Buchalter, D. B., Kirby, D. J., Teo, G. M., Iorio, R., Aggarwal, V. K., & Long, W. J. (2021). Topical vancomycin powder and dilute povidone-iodine lavage reduce the rate of early periprosthetic joint infection after primary total knee arthroplasty. The Journal of Arthroplasty, 36(1), 286-290. Web.

Finkelstein, R., Eluk, O., Mashiach, T., Levin, D., Peskin, B., Nierenberg, G., Karkabi, S., & Soudri, M. (2017). Reducing surgical site infections following total hip and knee arthroplasty: An Israeli experience. Musculoskeletal Surgery, 101(3), 219–225. Web.

Kuo, F.-C., Hsu, C.-W., Tan, T. L., Lin, P.-Y., Tu, Y.-K., & Chen, P.-C. (2021). Effectiveness of different wound dressings in the reduction of blisters and periprosthetic joint infection after total joint arthroplasty: A systematic review and network meta-analysis. The Journal of Arthroplasty, 36(7), 2612–2629. Web.

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., O’Connor, M., Corrigan, M., Burke, F., Hayes, M., Lynch, H., Sahm, L., Heffernan, E., O’Keeffe, E., Blake, C., Horgan, F., & Hegarty, J. (2019). Evidence-based practice education for healthcare professions: An expert view. BMJ Evidence-Based Medicine, 24(3), 103–108. Web.

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