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Quality improvement campaign reduces SSIs in hip, knee arthroplasties

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October 31, 2018

Photo of Michael Calderwood
Michael S. Calderwood

States participating in a quality improvement campaign aimed at reducing surgical site infections, or SSIs, experienced a significant reduction in the infections compared with non-participating states, according to study findings.

Prior research has showed that for every 1,000 hip and knee arthroplasties, roughly 6.9 patients develop a complex SSI, which are associated with an increased perioperative mortality rate, longer length of stay, higher cost of hospital care and additional procedures to address the infection. One study showed that the health care costs for patients who develop one of these infections are around $68,150 — nearly quadruple the cost for patients who do not. The U.S. Department of Health and Human Services established a goal to lower SSI rates by 30% by 2020. Without this reduction, it is estimated that SSIs will increase by 14% between 2020 and 2030.

In 2011, the Institute for Healthcare Improvement launched a quality improvement campaign, Project JOINTS — Joining Organizations In Tackling SSIs. The purpose of the campaign was to disseminate a prevention “bundle” to help reduce SSIs following hip and knee arthroplasty, according to Michael S. Calderwood, MD, MPH, regional hospital epidemiologist at Dartmouth-Hitchcock Medical Center and assistant professor of medicine at the Geisel School of Medicine at Dartmouth College, and colleagues, who studied whether states adopting the campaign had a reduction in overall SSI incidence.

“Given delays in translating best practice from clinical trials into the real world, Project JOINTS leveraged a network of state ‘nodes,’ mainly state hospital associations and quality improvement organizations, to disseminate a prevention bundle aimed at reducing SSIs following hip and knee arthroplasty,” Calderwood told Infectious Disease News. “Prior work already showed that hospitals in states that participated in Project JOINTS had increased their adoption of the prevention bundle over non-participating states. We were interested in evaluating the SSI outcomes in participating states compared to non-participating states.”

Calderwood and colleagues analyzed rates of SSIs among Medicare beneficiaries undergoing hip and knee arthroplasty during preintervention from May 2010 to April 2011 and postintervention from November 2011 to September 2013, in five states participating in Project JOINTS and five matched comparison states.

In intervention states, 125,070 patients underwent hip arthroplasty in 405 hospitals and 170,663 patients underwent knee arthroplasty in 397 hospitals. In nonintervention states, 131,787 patients underwent hip arthroplasty in 525 hospitals and 196,064 patients underwent knee arthroplasties at 518 hospitals. Following the campaign, patients in intervention states had 15% lower odds of developing hip arthroplasty SSIs and 12% lower odds of knee arthroplasty SSIs than patients in comparison states, according to Calderwood and colleagues.

“It was interesting that our sensitivity analysis found the impact of the Project JOINTS campaign to be greater on hip arthroplasty procedures than knee arthroplasty procedures,” Calderwood said.

According to Calderwood and colleagues, participating hospitals in intervention states had a higher hip arthroplasty SSI rates in the preintervention period than non-participating hospitals in the intervention states, potentially explaining why they enrolled to participate.

Calderwood said Project JOINTS showed that a multifaceted dissemination of materials, engagement of state quality improvement organizations and state hospital associations, and support from relevant professional societies, can successfully accelerate adoption and implementation of evidence-based practices and significantly impact patient outcomes on a large scale.

“New prevention practices are constantly being presented and published, but we need to better understand how to reduce the delays in changing clinical practice to improve patient outcomes,” he said. – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.