Surgical Site Infection in Hip Fracture Surgery; Reducing the Incidence of Infection and Correlation With co Morbidities and Blood Parameters

Abstract

Surgical site infections (SSIs) are associated with considerable morbidity and mortality. We aimed to reduce the infection rate in patients being treated for hip fractures at our unit over a period of two years by introducing an SSI policy incorporating the NICE guidelines. We compared the rate of superficial and deep wound infections prior to and after these measures in our unit and compared this to national data for surgical site infection in fracture hip patients. A comparison was also made between those patients with a wound discharge treated non-operatively (group A) versus operatively (group B). Haematological parameters were collated for patients with wound discharge in the hope of determining a cut off point at which Hb CRP and WCC might predict those patients requiring wound washout or debridement. 1101 patients underwent hip fracture surgery during 2010-2012. Of 62 patients with a wound discharge, 16 patients required surgical intervention of which 15 had a positive wound culture swab. The commonest pathogen was staph aureus. Although we were unable to find a single cut off point using ROC curves, we demonstrate that WCC and CRP are strongly correlated to the need for requiring surgical intervention. The infection rate at our unit was reduced to 1.36 % compared to a national rate of 2-3%. The presence of a senior surgeon performing or supervising these cases (78%) was an important component of reducing the SSI rate.