Does Standardization of Surgical Preparation Decrease Infection Rate in Closed Fracture ORIF?
Journal Title: Journal of Orthopaedic Science and Research - Year 2025, Vol 6, Issue 1
Abstract
Objective: To evaluate the effect of standardization of surgical prep on the deep infection rate for ORIF of closed fractures. Participants and Methods: As part of a quality improvement project, a total of 738 surgical cases were identified with discrete, new onset, closed fractures that were treated with surgery following standardization of practice for surgical prep from September of 2016 through November of 2017 at an ACS level I trauma center. A retrospective chart review included prep type, compliance with dry times of surgical preparation and the surgical procedure. Patients with multiple fractures were given separate entries for fractures that occurred at different anatomical sites. Adequate follow-up for patients to be included in the study group was 6 weeks minimum at our facility. The endpoint was return to the OR for deep infection prior to fracture healing. Data from 2 years prior to instituting the protocol served as the control group. Results: Out of 738 patients, 25 patients (3.38%) returned to the OR for deep infection. The historical control infection rate for the previous 2 years was 5.7% (105/1827). Therefore, the standardization project led to a decrease of 2.32%. A Z-test showed a statistically significant decrease in infection risk with a z-score of 2.466 (P=.0068 95% CI .007-.04). 542/738 (73.4%) followed standardization procedures as described. 702/738 (95.1%) used chlorhexidine containing solution as the final step and complied with dry times before incision. Conclusion: Standardization of surgical prep in the setting of ORIF of closed fractures significantly decreased the risk of post-operative infection requiring operative debridement. Standardizing the surgical prep minimizes confusion by staff who perform the prepping and increases consistency. These effects were seen in the setting of using an alcohol pre-prep followed by use of an alcohol-based chlorhexidine final prep.
Authors and Affiliations
Smith MD1, Brett D Crist1*, Michael W Robertson2, Mauricio Kfuri1, James P Stannard1, Matthew J Smith1
Keywords
Related Articles
- EP ID EP756105
- DOI https://doi.org/10.46889/JOSR.2025.6103
- Views 30
- Downloads 0
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