1. Orthopedic Residents and Fellow Orientation Maureen Spencer, RN, MEd, CIC Infection Control Manager New England Baptist Hospital Boston, Mass. 02120 [email_address]

3. NEBH Goal: Zero Healthcare-Acquired Infections

6. The Patient as a Source Risk factors leading to colonization and infection

10. Skin Issues in Orthopedic Surgery

11. Postop Dressings

12. Leaving Incisions Open To Air We discourage this practice – bacteria feed off of blood (and sugar), incisions are in first few days of wound healing – “exudative stage” and need protection

13. Postop Dressings - ABD with Paper Tape Previously done by residents and PAs ABD tends to fall off easily Paper tape can cause skin tears – obese patient sweat and tape absorbs in pores and then pulls off skin upon removal

14. Antimicrobial Dressing (AMD) and Sterile ABD dressing with MeFix Tape

15. MicroFoam Dressing with AMDs Some surgeons apply Microfoam over steristrips, adaptic, gauze, ABD until day 2 postop Tends to wrinkle and lose adhesion

16. Total Knees and Hips with Dermabond Apply one layer of Dermabond Allow to dry - ~ 2-5 minutes Can apply telfa – but not necessary Apply transparent dressing over telfa

17. Dermabond and AMD Dressing Left- Incision covered with with AMD gauze (hip) Below - AMD telfa (knees) and a tegaderm Healed incision

18. Knee Dressings with Ace ABD over knee incision Ace bandage one day postop with blood strikethrough after drain removed – “reinforce” AMD gauze are in postop dressing kits so they are offering protection to the incision in first two days

19. Spine Service and Shoulders Aquacel, AMD, Tegaderm left on until discharge AMD Island dressing – left on until discharge Incision sealed with Dermabond and covered with AMD gauze and tegaderm until discharge

23. What were the outcomes?

28. Staff Items as Sources for Cross Contamination

31. Prevention Measures

33. MRSA VRE Abscesses Cellulitis Draining wound infections Significant continence with feces

34. Clostridium difficile Infection Must wash hands to remove spores and clean equipment with bleach wipes

35. Contaminated Hands Most Common Source

38. Wear Gloves, Wash Hands Often, Use Alcohol Based Hand Rub/Foam

39. Hand Cultures – before and after the use of Cal Stat

40. Action Plans for Patients

45. NEBH SSI Rates 2003 - 2010 Team Analysis of Surveillance Data: 2007 Laminectomy increase rate: case/control study confirmed it was due to the use of locally administered steroids (depomedrol) 2008 Total knee infection rate increase: evaluation revealed the use of instilled pain medications in joints – preparation technique questionable 2009 Total hip infection rate increase: ?due to increase in post-op hematomas – case/control study underway to evaluate risk factors