Reducing surgical site infections following total hip and knee arthroplasty: an Israeli experience.
To assess the changes observed in surgical site infection (SSI) rates following total joint arthroplasty (TJA) after the introduction of an infection control programme and evaluate the risk factors for the development of these infections.



Prospective cohort study.



Large tertiary medical centre in Israel.



Data about SSIs and potential prophylaxis-, patient-, and procedure-related risk factors were collected for all patients who underwent elective total hip and total knee arthroplasty during the study period. Multivariant analyses were conducted to determine which significant covariates affected the outcome.



During the 76-month study period, SSIs (superficial and deep) occurred in 64 (4.4%) of 1554 patients. As compared with the 34 (7.7%) SSIs that occurred in the first 25 months, there were 23 (4.7%) SSIs in the following 25 months, and only 7 (1.3%) SSIs in the last third of the study (p = 0.058 and <0.001, respectively). A multiple logistic regression model indicated that risk factors for prosthetic joint infection were a National Nosocomial Infections Surveillance (NNIS) System surgical patient risk index score of 1 (OR 1.8; 95% CI 1.1-3.1) or 2 (OR 2.8; 95% CI 1.2-11.8). The incidence of SSI was not correlated with the timing, nor the duration of antibiotic prophylaxis.



The introduction of preventive measures and surveillance coincided with a significant reduction in SSIs following TJA in our institution. The risk of infection correlated with higher scores in the NNIS System surgical patient risk.
Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel. renatof@bezeqint.net.|The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. renatof@bezeqint.net.
R
R
Finkelstein
Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel.
O
O
Eluk
Infectious Diseases Unit, Rambam Medical Center, Rechov Alia Shnia, 31096, Haifa, Israel.
T
T
Mashiach
Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel.
D
D
Levin
Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel.
B
B
Peskin
Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel.
G
G
Nierenberg
Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel.
S
S
Karkabi
Department of Orthopaedic Surgery, Rambam Medical Center, 31096, Haifa, Israel.|The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
M
M
Soudri
D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
Antibiotic prophylaxis; Hip arthroplasty; Infection control; Knee arthroplasty; Surgical site infections; Total joint arthroplasty