Orthopedic / Device Related Nosocomial Wounds

SCAHQ MeetingMay 14, 2010

Introduction - 2006

Observed an increase in wounds related to medical devices in post-op hip and knee patients

Devices used on patients with nosocomial wounds

Immobilizer Ace wrap Plexi-pulse Multipodus boot TED hose Heel protector Bucks traction

Cause for concern

5 TKA

2 Other

5 TKA

2 Hip

2 Other

7 TKA

5 Hip

2 Femur

Action Plan - June 2006 Hip/knee protocol

Turn Schedule Patient helper (trapeze bar) Foot/heel assessment Patients seen by Wound Care nurses

within 72 hours of surgery Continue wound care visits until

transferred to SSCP or ARU or discharge

Results of Initial Action Plan

Wounds by procedure - 2007

Process Improvement – Change to Trigger Tool

Wound Care nurses realized patients with femur fractures were not evaluated

In March, the trigger tool was changed to include femur fractures

Surgical schedule also being checked for surgical procedures; wound care nurses then have opportunity to assess patient

Study of results

July:Action Plan Implemented

July:

Action Plan implemented

March:Trigger revision

Nosocomial Wounds

5 TKA

2 Other

5 TKA

2 Hip

2 Other

7 TKA

5 Hip

2 Femur

0 TKA

1 Hip

1 Femur

1 TKA

3 Hip

4 Femur

1 Tibia

1 TKA

3 Hip

1 Femur

1 THR

2 Hip

1 Ankle

1 Femur

2 TKA

2 Hip

1 Hip 1 Hip 1 TKA

2 Hip

Actions Taken Education of nursing staff Joint Camp

Patient education provided on wound survelance

Expect visit from wound care nurse Patients evaluated within 72 hours

Revision of trigger to capture femur fractures

Check surgery schedule

Results

* Nosocomial wounds/patients seen by wound care nurses

All Nosocomial Wounds

2006 - 2009 Comparison

Consults vs. Admissions

consults 198 239 249 270 315 317 319 312 352 342 387 355 356 382 397 341 405

admissions 3223 3000 3017 3166 3257 3068 3307 3062 2590 2604 2630 2520 2483 2457 2417 2504 2635

Never Events

Apparent Cause Meeting All Stage III and IV nosocomial pressure

ulcers Occurrence reports completed by wound

care nurses

Nosocomial Wound Rate

Wound rate = # Patients/# patient days x 1000

New cause for concern?

Increase in nosocomial wounds Unknown causes at this point Do not feel it is due to lack of education

Competency Fair Staff Meetings Next Steps

National trend in increase of nosocomial wounds in ICU Patients sicker when admitted? More multi-system organ failure?

QUESTIONS?