The prevention of surgical site infections, specifically orthopedic surgery cases, has been cited as the most preventable source for morbidity and mortality for patients undergoing total knee arthroplasties (TKA). In the most recent Veteran Affairs (VA) National Surgery Office Quarterly Report (July 1, 2012 through June 30, 2013), a problem with surgical site infections was identified in patients with TKA surgery at Dayton Veterans Affairs Medical Center (VAMC). The Dayton VAMC had a 5.3% TKA surgical infection rate versus 1.3% nationally.
The purpose of this quality improvement project was to decrease post-operative TKA infection rates with utilization of evidence based practice (EBP), at the Dayton Veterans Affairs Medical Center. A PICOT question was developed: In total knee arthroplasty surgery patients, how does implementation of a revised Total Knee Care Management evidence based practice guideline, compared to current care, affect wound infection rates within 30 postoperative days?
The Iowa Model of Evidence-Based Practice was selected by the Project Director (PD) to guide the EBP quality improvement project, in which stakeholders were instrumental in the project. The TKA Guideline included multi-day 2% chlorhexidine gluconate pre-operative scrubs and silver infused dressings post-operatively. Following stakeholder education, the TKA evidence based guideline was implemented for a three month period. Compliance with the process and post-operative infection results within 30 days post-operatively were monitored. The outcome of the implementation of this TKA evidence based guideline was effective with a decrease in post-operative TKA infection rate to 0%. Finally, analysis of cost, benefits and sustainability of this evidenced based guideline is discussed.
Kimpton, P. A. (2014). Implementation of a Total Knee Arthroplasty Evidence Based Practice Guideline Quality Improvement Project in a VA Orthopedic Surgical Setting to Reduce Surgical Infections. . Wright State University, Dayton, OH.