Reducing Surgical Site Infections in Fractured Neck of Femur Patients: A Closed Loop Audit and Literature Review

Abstract

OBJECTIVE: To establish the incidence and identify the risk factors correlated to surgical site infections (SSIs) in geriatric patient having a surgery of fractured neck of femur in a district general hospital (DGH).
METHODOLOGY: An initial audit was done for all fractured neck of femur patients who underwent for surgery in a three-month period. Electronic records were checked, and case notes were reviewed. After the initial audit, recommendations were made and the incidence of SSIs was re-audited 16 months later in 2 sessions (2nd and 3rd Audit).

RESULTS: The initial audit in 89 patients showed an infection rate of 8.9% of which half were deep infections. The mean age was 79 years. Four superficial and 4 deep infections were identified. Patients with superficial infection had, Fixation with DHS, THR, Hemiarthroplasty and IM nailing. Patients with Deep infection had fixation with Dynamic hip screw (DHS), Cannulated hip screw (CHS), Hemiarthroplasty and IM nailing respectively, A Re-audit of 184 patients in 2 sessions (2
Audit) showed the infection rate reduced to 0.54%. One patient with infection had hemiarthroplasty, with mean age of patients was 80 years.
CONCLUSION: Multiple techniques can be used to reduce Surgical site infection in fracture neck of femur patients and infection can be reduced to acceptable level such as Senior surgeon operating or Direct supervision, Pre-operative on table skin wash with chlorhexidine soap solution, Use of alcoholic betadine and Chlorhexidine, Two Opsite technique to isolate groin area, Non-braided suture for closure and layered washout, Re application of Chlorhexidine to skin prior to closure.