Journey to zero serious bacterial prosthetic joint infection

Deep infections following primary joint replacement cause great suffering to patients and have high treatment costs.1 In the general population, and especially in those that have recent contact with healthcare facilities, the bacteria Staphylococcus aureus often colonise the skin and the upper airways without causing disease. However, indolent in the skin, the same bacteria may cause devastating infection associated with implant devices and not least in orthopaedic surgery. There is extensive literature on specific measures aimed at reducing patients’ own bioburden with S. aureus before surgery summarised in the National Institute of Health and Care guidelines.2 3 Universal strategy is more cost-effective than a ‘screen and treat’ strategy.2 Use of triclosan-coated sutures is recommended by several major public health organisations.2 4 5 In contrast, we found one single publication describing the effect of prolonged decolonisation on the incidence of prosthetic joint infection (PJI) after surgery.6 However, there has been more attention towards postoperative factors on PJI.7 In an overall ‘zero harm’ healthcare improvement project at Drammen Hospital (DH) and Kongsberg Hospital (KH), part of the Vestre Viken Hospital Trust, we aimed to eliminate the incidence of PJI caused by S. aureus . Compliance with the decolonising protocol is a major issue for success. Hence, in this quality improvement project, we developed a highly standardised protocol for all patients admitted for acute (hip only) and planned surgeries (hip, knee, shoulder). The combined intervention included use of triclosan-coated sutures and patient decolonisation on the incidence of …