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Stricter infection control policies reduced infection rates after elective foot and ankle surgery

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Andrew P. Molloy

KEYSTONE, Colo. – Following stricter infection control policies reduced the rate of infection in patients who underwent elective foot and ankle surgery, according to a study presented here.

“Infection is probably the most feared complication of our patients,” Andrew P. Molloy, MBChB, said at at the 2011 Meeting of the American Orthopaedic Foot and Ankle Society. “It has a high media profile.”

Molloy and his team conducted a prospective study to determine if new infection control policies followed between 2005 and 2010 reduced infection rates. The team studied 1,737 foot and ankle surgery patients. Between 10 days and 17 days postoperatively, patients returned for a nurse-led dressing clinic. The nurses used a standard proforma based on the type of surgery to examine thepatients’ wounds.

The team began following stricter infection control policies in 2008 including new skin closure techniques, new operating room regulations and the creation of a Joint Replacement Unit. The Joint Replacement Unit includes an orthopedic-only ward where only permanent ward staff are allowed, and has a locked-door policy, basins and automatic hand dryers outside the door. All patients must have a current MRSA screen, and pyrexial patients are moved from the ward and no invasive devices are allowed in the Joint Replacement Unit, according to Molloy.

For the new operating room regulations, hats and gloves are worn at all times, scrubs may not be worn outside the operating room, kits are opened under laminar flow, and gloves must be worn for starting intravenous lines. Also, only one dose of prophylactic antibiotics are given, temperature and glycemic controls are monitored and recorded and the entire operating room is cleaned with antiseptic between patients, according to Molloy.

There was a decrease in infection rates after the policies were enforced, he said. Before the stricter infection control policies were enforced, of 818 patients, 3.6% had superficial infections and 0.7% had deep infections. Of the 919 patients studied after the stricter policies were in place, 1.6% of patients had superficial infections and 0.3% had deep infections.

“Strict infection control policies work,” Molloy said.

Reference:

• Molloy AP, Butcher C, Simmons D, et al. Effect of strict infection control policies on infection rates in elective foot and ankle surgery. Paper #82. Presented at the 2011 Annual Meeting of the American Orthopaedic Foot and Ankle Society. July 13-16. Keystone, Colo.
• Disclosure: Molloy has no disclosures.

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