Advances have been made through the years on infection control practices. However, despite these practices, surgical site infections (SSIs) remain a concern among healthcare institutions. This section aims to show the trends in clinical quality outcomes of the hospital with regards to surgical site infections. From these data we take note, analyse, and implement processes and procedures to better improve our patient outcomes.
Hip Arthroplasty
Hip arthroplasty or hip replacement is an orthopaedic surgical procedure in which the diseased parts of the hip joint are removed and replaced with artificial parts or prostheses. It can be a total hip arthroplasty (THA) or a hemi-arthroplasty. THA involves the replacement of both the head and neck of the thigh bone (femur), and the inner surface of the hip socket (acetabulum). Hemi-arthroplasty replaces only the head portion of the femur.
This review covers the surgical site infection rates for hip arthroplasty in NUH from 2005 to the first half of 2009.
Early Infection
Early SSIs are those that occur within 30 days after the procedure. This may be influenced by the peri-operative environment (before, during and after the procedure).
An average of 50 patients a year underwent THA in NUH from 2005 onwards. The SSI rates have declined steadily from 4.44% (2/45) to zero (0/20) in 2008 and in the first half of 2009 (Figure 1).
For Hemi-arthroplasty, an average of 76 patients undergo surgery per year. The rates have come down from 3.9% (3/77) in 2005 to zero (0/53) in the first half of 2009 (Figure 2).
Late infection
Late infections, which may occur within 1 year post-operatively, are also followed up in NUH. This may be influenced by the following:
- Advanced age
- Underlying medical conditions like diabetes mellitus
- Local infections that may spread via the bloodstream (like UTI, pneumonia)
Only one SSI case was reported so far at 1 year follow-up for THA patients operated on from 2005 to 2007 (Figure 1).
There is no reported infection at 1 year follow-up for hemi-arthroplasty in 2005 (0/69) and one case each in 2006 and 2007 (Figure 2). As patients in 2008 have yet to be followed up until the end of 2009, data for this group are not yet available as of this writing.
Figure 1: SSI rates for Total Hip Arthroplasty (THA) at 30 days and at 1 year follow-up
NOTE: Denominators for the above rates are as follows: 30-days follow-up:2005=45; 2006=47; 2007=66; 2008=45; Q1-Q2 '09=20. 1-yr follow-up: 2005=43; 2006=41; 2007=54.
Data source: Infection Control, NUH
Figure 2: SSI rates for Hemi-arthroplasty at 30 days and 1-year follow-up
NOTE: Denominators for the above rates are as follows: 30-days follow-up: 2005=77; 2006=67; 2007=64; 2008=80; Q1-Q2 '09=53. 1-yr follow-up: 2005=69; 2006=51; 2007=40.
Data source: Infection Control, NUH
Our rates are comparable with those of US and UK hospitals. The National Healthcare Safety Network (NHSN, US, 2008) reports an average of 1.5% overall SSI rate for hip arthroplasty (both, total and hemi-arthroplasty). The UK reports SSI rates of less than 1% for total hip arthroplasty and 2.2% for hemi-arthroplasty (Health Protection Agency, 2008/09 Report).
'Zero SSI' for hip arthroplasty (THA and hemi-arthroplasty) within 30 days follow-up for the first half of 2009 is indeed a good outcome, made possible by the continuous quality improvement efforts of our doctors and nurses in NUH.
Information is correct as at November 2009
Footnotes
- "Surgical Site Infection (SSI) Event", Centers for Disease Control Website, http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf, accessed on 9 November 2009
- Edwards, JR, et al, "National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008", Am J of Infectious Control, Vol. 36, No. 9 http://www.cdc.gov/nhsn/PDFs/dataStat/2008NHSNReport.pdf accessed on 9 November 2009
- "Healthcare Associated Infections in England: 2008 – 2009 Report", August 2009, Health Protection Agency http://www.hpa.nhs.uk/web/HPAwebFile/HPAweb_C/1252326222452 accessed on 9 November 2009
This material does not cover all information and is not intended as a substitute for professional care. Please consult your physician on any matters regarding your health.
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