Elective hip and knee total joint replacement surgeries resume Monday, Jan. 29 at Kootenay Boundary Regional Hospital. (Sheri Regnier/Black Press)

Joint replacement surgeries resume at KBRH

Increased infections put elective hip and knee surgeries on hold in December

  • Jan. 29, 2018 12:00 a.m.

TRAIL — Orthopedic surgeries on-hold at the Trail hospital for the past month have resumed, Interior Health (IH) confirmed.

Scheduled hip and knee total joint replacements were halted at Kootenay Boundary Regional Hospital (KBRH) in December. The decision to temporarily stop these specific types of surgery, affecting 37 patients, followed an increase in the number of surgical site infections.

After six patients were confirmed with various strains of post-op infections, IH launched a formal review.

While a number of improvements were identified through the review, IH stated, “no specific cause for the increase in surgical site infections was identified through a thorough examination of the patient charts, KBRH surgical processes, or the operating room (OR) environment.”

“There was no specific organism found in these cases or a specific item that we can point to and say, ‘That’s the problem,'” stated Dr. Ron Cameron, KBRH’s general surgeon and perioperative medical director, on Friday.

“Given the wide variety of factors that can contribute to surgical site infections, we knew pinpointing a specific reason for the increased infections would be unlikely,” he clarified.

“This review was valuable in that it allowed us to look at the patient’s surgical journey and examine the range of risks and make some improvements to our processes and to the ORs themselves.”

IH is in process of contacting patients to book total hip and knee procedures. Those individuals whose surgeries were delayed will be reassessed as needed and rebooked as priority cases.

“We know a delay in these major surgeries do impact these patients and we regret that some individuals had to wait longer for their procedures,” said Cameron.

“Above all, Interior Health and our local orthopedic surgeons took these actions to ensure our patients are receiving safe, quality care and have the greatest chance of a successful and safe procedure and recovery.”

The review involved Interior Health and external specialists in infection prevention, control and surgical practices.

A “Surgical Quality Working Group,” which included orthopedic surgeons, was established early in the review to analyze and monitor ongoing surgical processes and practices at KBRH.

Surgical processes for every total joint replacement surgery will be tracked and audited for ongoing quality assurance purposes, stated IH, adding, “and any future surgical site infections in total joint replacement surgeries will be thoroughly reviewed.”

Based on the review by infection control experts and the surgical working group, enhancements or improvements in three general areas have been put into practice.

First, upgrades were recommended to the OR wing that included improved filters for the OR air system and system upgrades in real-time monitoring of air pressure and airflow.

“The entire air system was thoroughly cleaned and rebalanced to ensure appropriate airflow through the ORs, and an updated maintenance schedule for the system is in place,” IH stated. “Minor repairs to some surface areas are proceeding.”

The review also determined that pre-surgical screening could be improved to identify and support patients at higher risk of infection, such as smokers and those with pre-existing conditions like obesity and diabetes.

“Based on the review, IH will enhance the triage process for patients awaiting total joint replacement surgeries, ensuring patients who are at higher risk of infection are identified and supported early in their journey to reduce those risk factors wherever possible,” IH clarified.

“A tool identifying patient risks and recommended follow-up prior to surgery for those with significant risks are being implemented that will follow a patient from their initial visit with their family physician all the way through the surgical process, from pre-surgical screening to post-operative and community care.”

This measure is meant to increase consultation opportunities with internal medicine specialists and connect individuals with IH clinicians such as dietitians, physiotherapists, or home care nurses, to give patients the greatest chance for success with their surgery and reduce the risk of infection.

Finally, an internal review by IH infection prevention and control practitioners highlighted current standards and best practices for preventing surgical site infections.

“IH Infection Prevention and Control is providing education and updated information to the surgical team related to current standards around items such as dosage for antibiotic prophylaxis prior to surgery,” IH stated.

“IH will have a dedicated RN or coordinator based in the medical device reprocessing (equipment sterilization) department to enhance ongoing quality assurance and monitoring of those processes.”

In light of these steps, orthopedic surgeons and Interior Health agreed to resume total hip and knee joint replacement cases beginning Jan. 29.