PROSPECTIVE STUDY OF OPERATIVE SITE INFECTIONS OBSERVED OVER A FOUR-YEAR PERIOD: ANALYSIS OF 8811 ORTHOPEDIC SURGERY PROCEDURES

Purpose of the study: Surveillance of operative site infections (OSI) is a persistent problem in orthopedic surgery. In France, a specific administrative directive was issued on December 29, 2000 to regulate surveillance of OSI. Material and methods: Based on evidence reported in the literature, the efficacy of any surveillance plan requires a sufficiently dense data base obtained by long-term and systematic registration of all significant information concerning all orthopedic surgery patients. Of particular importance are the ASA score, Altmeier, and antibiotic prophylaxy. During the five-year period from 1999 through 2004, a total of 8811 consecutive orthopedic surgery procedures were followed prospectively. Infections detected were registered using a dedicated software. The hospital hygiene committee and the referring surgeon performed the follow-up. Results: On average, infection developed four months after surgery. The rate of infection was 1.2% in 1999 and declined to 0.6% in 2003 with the implementation of a few prophylactic measures. It was possible to determine which operations and which patients were at risk using as criteria the type of operation and the ASA score. Discussion: Surveillance of OSI, with adjustment for risk factors, enabled a measurement of the risk of infection and enabled us to recognized a trend within our department. This study enabled us to define the level of risk for our patients and also develop a new preventive policy. Our findings led us to modify certain practices. Certain data reported in the literature concerning antibiotic prophylaxy were confirmed. Conclusion: This work demonstrated the importance of following operative site infections, disclosed the implications for medical and hospital personnel, and demonstrated the efficacy of preventive measures for decreasing the rate of these infections.