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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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