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Outbreak of Surgical Wound Infections Associated With Total Hip Arthroplasty

Published online by Cambridge University Press:  21 June 2016

Consuelo M. Beck-Sague ,
Wang H. Chong ,
Connie Roy ,
Roger Anderson  and
William R Jarvis
Consuelo M. Beck-Sague*
Affiliation:
Hospital Infections Program, Centers for Disease Control, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
Wang H. Chong
Affiliation:
Hospital Infections Program, Centers for Disease Control, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
Connie Roy
Affiliation:
Infection Control, Penobscot Bay Medical Center, Rockland, Maine
Roger Anderson
Affiliation:
Hospital Infections Program, Centers for Disease Control, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
William R Jarvis
Affiliation:
Hospital Infections Program, Centers for Disease Control, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia
*
Investigation and Prevention Branch, Building 3, Room B-49, Mailstop A-07, Centers for Disease Conrol, 1600 Clifton Rd., Atlanta, GA 30333
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Abstract

Objectives:

Describe an outbreak of surgical wound infections associated with total hip arthroplasty; identify risk factors for surgical wound infection during the pre-outbreak and outbreak periods.

Setting:

A 100-bed hospital. From May 1 to September 30, 1988, 7 of 15 patients who underwent total hip arthroplasty developed surgical wound infections from Staphylococcus aureus (5), Enterobacter cloacae (1), b-hemolytic streptococci (1), enterococci (1), coagulase-negative staphylococci (1), and Escherichia coli (1) (attack rate = 46.7%).

Design:

Retrospective cohort studies comparing surgical wound infection rates by patient-and procedure-related risk factors during the pre-outbreak and outbreak periods were conducted. Drop plate quantitative air culturing was conducted in 10 consecutive total hip artbroplasties in the subsequent 6 months.

Results:

Rates of surgical wound infection were significantly higher for arthroplasties in which no intraoperative prophylactic antimicrobials were given (44% versus 8%, relative risk [RR] = 5.4, p= .01), or in which the posterior approach (20% versus 3%, RR= 6.7, p = .04) or a specific prosthesis (39% versus 5%, RR=6.3, p = 0.01) was used. The surgical wound infection rate was highest when one circulating nurse, Nurse A, assisted (47% versus 4%, RR= 12.8, p<.001). Logistic regression analysis identified use of the posterior approach (RR= 1.8, p= .04) and Nurse A's participation (RR= 5.0, p <.001) as independent risk factors for surgical wound infection. Interviews of the nursing supervisor indicated that Nurse A had recurrent dermatitis on her bands. During 6 months following Nurse A's reassignment, the rate declined significantly (from 7/15 to 0/10, p=.01). Drop plate culturing yielded 2 to 10 colonies per plate of organisms that did not match outbreak organisms.

Conclusions:

Outbreaks associated with personnel generally involve only 1 species. In this outbreak, Nurse A (possibly because of her dermatitis), technique, the posterior approach, and/or other undetermined factors were the primary predictors of surgical wound infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 9 , September 1992 , pp. 526 - 534
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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References

1. Graves, EJ. Detailed diagnoses and procedures, National Hospital Discharge Survey, 1988. National Center for Health Statistics. Vital Health Stat. 1991;13:107.Google Scholar
2. Poss, R, Thomhill, TS, Ewald, FC, et al. Factors influencing the incidence and outcome of infections following joint arthroplasty. Clin Orthop Rel Res. 1984;182:121–126.CrossRefGoogle Scholar
3. Agins, HG, Salvati, EA, Ranawat, CS, et al. The nine-to-ftieen year follow-up of one-stage bilateral total hio arthroplasty. Orthop Clin North Am. 1988;19:517–530.CrossRefGoogle Scholar
4. Nelson, JP, Musculoskeletal infection. Surg Clin North Am. 1980;60:213–220.CrossRefGoogle ScholarPubMed
5. Hill, GE, Droller, DG. Acute and subacute deep infection after uncemented total hip replacement using antibacterial prophylaxis. Orthop Rev. 1980;18:617–623.Google Scholar
6. Pollard, JP, Hughes, SP Scott, JE, et al. Antibiotic prophylaxis in total hip replacement. Br Med J. 1979;1;707–709.CrossRefGoogle ScholarPubMed
7. Nelson, JP Glassburn, AR, Talbott, RD, McElkinney, JR The effect of previous surgery, operating room environment, and preventive antibiotics on postoperative infections following total hip arthroplasty. Clin Orthop. 1980;147:167–169.CrossRefGoogle Scholar
8. Salvati, EA, Robinson, RP, Zeno, SM, et al. Infection rates after 3,175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg. 1976;58-A:446–450.Google Scholar
9. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–140.CrossRefGoogle ScholarPubMed
10. Infections of Skeletal Prostheses in Hospital Infections. Bennett, JV, Brachman, PS, eds. Boston, Mass: Little, Brown and Co.; 1979.Google Scholar
11. Dean, AG, Dean, JA, Burton, AT EpiInfo User's Manual. Atlanta, Ga: Centers for Disease Control; 1987.Google Scholar
12. Rosner, BA. Fundamentals of Biostatistics. Boston, Mass: Duxbury Press; 1982.Google Scholar
13. Fleiss, JL. Statistical Methods for Rates and Proportions. New York, NY: John Wiley and Sons; 1981.Google Scholar
14. Engelman, L. Stepwise logistic regression. In: Dixon, WJ, ed. BMDP Statistical Software Manual. Los Angeles, Calif: University of California Press; 1985:330–346.Google Scholar
15. Chan, W, Hoskinson, J. Thompson prosthesis for fractured neck of femur: a comparison of surgical approaches. J Bone Joint Surg. 1975;57:437–443.CrossRefGoogle ScholarPubMed
16. Nelson, JR Musculoskeletal infection. Surg Clin North Am. 1980;60:213–218.CrossRefGoogle ScholarPubMed
17. Fitzgerald, RH, Thompson, RL. Cephalosporin antibiotics in the prevention and treatment of musculoskeletal sepsis. J Bone joint Surg Am. 1983;65:1201–1205.CrossRefGoogle ScholarPubMed
18. Hill, C, Mazas, F, Flamant, R, Evrard, J. Prophylactic cefazolin versus placebo in total hip replacement. Lancet 1981;i:795–797.CrossRefGoogle Scholar
19. Doyon, F, Evrard, J, Mazas, E, Hil, C. Long-term results of prophylactic cefazolin versus placebo in total hip replacement. Lancet. 1987;i:860.CrossRefGoogle Scholar
20. Kaiser, AB. Antimicrobial prophylaxis in surgery. N Engl J Med. 1986;315:1129–1138.Google ScholarPubMed
21. Richet, HM, Jarvis, WR, Tablan, OC. A cluster of Rhodococcus bronchialis sternal wound infections after coronary artery bypass surgery. N Engl J Med. 1991;324:104–109.CrossRefGoogle Scholar
22. Gordon, SM, Culver, DH, Simmons, BR Jarvis, WR. Risk factors for wound infections after total knee arthroplasty. Am J Epidemiol. 1990;131:905–916.CrossRefGoogle ScholarPubMed
23. Garner, JS. CDC guidelines for prevention of surgical wound infections. Infect Control. 1986;7:193–200.CrossRefGoogle Scholar