Most Proposed Topic :
Clinical Safety and Quality Service II (projects aiming to enhance clinical safety and outcomes, clinical governance)
Authors: (including presenting author): :
Wong NM, Tsui YN, Li C, Tso YF, Chan LH
Affiliation: :
Orthopaedic & Traumatology Department, Princess Margaret Hospital
Introduction: :
Surgical site infection (SSI) after acute hip fracture operation is a life-threatening complication which would increase mortality and suffering in patients, especially those patients are generally in old age with multiple co-morbidities. It may result in re-operation, increased length of stay, medication expenditure and hospital cost. Concerning the uprising SSI rate in O&T department in 2022, from total 0.82% (5/596 cases) in 2021 to 3.57% (5/114 cases) in first quarter of 2022, MRSA SSI Reduction Program for Geriatric Hip Fracture Patients was carried out on 31 Oct 2022 in PMH.
Objectives: :
1) Early detection of MRSA carrier; 2) To reduce MRSA SSI rate in Geriatric hip fracture operation of O&T Patients.
Methodology: :
With effective from 31 Oct 2022: 1) Perform screening of carriage to control MRSA. Take nasal swab and axillary swab for culture on admission of ≧65 years old hip fracture patient. 2) Routine 2% chlorhexidine (CHG) wash cloth as skin disinfection for pre-operative preparation one day before and on the day of operation. 3) Switch antibiotic to Vancomycin accordingly as prophylactic antibiotic if MRSA was detected. 4) Apply silver dressing (i.e., Mepilex Ag Post –op dressing) on post operation surgical wound until stitches/staples removed. 5) If MRSA screening was positive, apply 2% Mupirocin intranasal ointment and 4% chlorhexidine wash cloth/shower/cleaning for 5 days.
Result & Outcome: :
After the program started, the SSI rate for Dynamic Hip Screw was 3.33 in 2Q 2023 while the SSI rate was 3.43 in 2022. The SSI rate for Hip prosthesis was 0 in 2Q 2023 while that SSI rate was 3.52 in 2022 in PMH.
