Implementation of a Surgical Site Infection Prevention Bundle in Elective Total Hip and Knee Arthroplasties: An Evidence-Based Practice Project

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Purpose: This evidence-based practice (EBP) project aimed to determine whether implementing a standardized, evidence-based surgical site infection (SSI) prevention bundle reduced SSIs in adult patients undergoing elective total hip or knee arthroplasty compared to the varied standard practices amongst surgeons. Total hip and knee arthroplasties are major surgeries where the arthritic or diseased bone is removed and replaced with prosthetic implants. Background: Although SSIs inflict a relatively small percentage of total procedures, the physical, emotional, and fiscal implications of each SSI are many. Additional exams, studies, and surgeries increase patients' length of stay and morbidity and mortality. In addition, with an aging population, there will be a greater demand for total joint arthroplasties, coupled with increased scrutiny on spending. This underscores why hospitals, surgery centers, and other facilities must remain steadfast in preventing SSIs. Method: The framework utilized was the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP). This EBP project tracked all patients undergoing elective total hip or knee arthroplasties in a designated period over 90 days. Additionally, the National Healthcare Safety Network (NHSN) tool was utilized to identify any potential SSIs that required escalation. The difference in pre-and post-bundle implementation SSI rates determined the effect of said bundles on SSI rates.

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