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Risk factors of surgical site infection in total knee arthroplasty: Impact of an infection prevention and control intervention in a tertiary hospital in Barcelona, Spain
Journal
American Journal of Infection Control
ISSN
0196-6553
Date Issued
2026-01
Author(s)
Zules Oña Ricardo Gabriel
Hospital Universitari Vall d'Hebron, Hospital Universitari de Girona Doctor Josep Trueta, Ministerio de Sanidad, Consumo y Bienestar, Organización Panamericana de la Salud Ecuador, Sociedad Española de Calidad Asistencial, Universidad Tecnológica Equinoccial, Universidad de Las Américas, Universitat Pompeu Fabra
Susana Otero-Romero
Jose Angel Rodrigo-Pendás
Joan Minguell-Monyart
Carles Amat-Mateu
Mayli Lung
Xavier Martínez-Gómez
Cristian Quintana-Alonso
Enric Limón
Oleguer Parés-Badell
Abstract
Background In early 2018, we detected an increase in surgical site infections (SSI) after total knee arthroplasty in a tertiary hospital in Barcelona.
We implemented an infection prevention and control (IPC) intervention reinforcing preventive bundles and reorganizing surgical schedules for high-risk patients and senior surgeons.
We aimed to identify SSI-associated factors and evaluate the IPC intervention’s impact. Methods We conducted a retrospective cohort study in 2018 with 90-day follow-up. SSI rates were compared pre- and post-intervention.
Preintervention risk factors were assessed using Cox models. Differences in associated factor distributions were estimated. Kaplan-Meier and log-rank tests evaluated incidence, and a sensitivity analysis was stratified by American Society of Anesthesiologists (ASA) and National Nosocomial Infection Surveillance (NNIS) risk. Results Among 463 patients, overall SSI incidence was 0.52 per 1,000 patient-days. Incidence significantly declined postintervention (pre: 0.75; post: 0.26; P = .030).
Obesity (HR: 3.63; 95% CI: 1.02-12.86) and afternoon surgery (HR: 3.02; 95% CI: 1.02-8.92) were associated. High ASA, NNIS risk, and inadequate prophylaxis significantly decreased (P ' .001).
The intervention reduced SSI risk by 66% (HR: 0.34; 95% CI: 0.13-0.94; P = .037). A nonsignificant reduction was seen in high-risk strata.
Conclusions
Our study showed the impact of an IPC intervention addressing associated factors and significantly reducing SSI incidence rates.
We implemented an infection prevention and control (IPC) intervention reinforcing preventive bundles and reorganizing surgical schedules for high-risk patients and senior surgeons.
We aimed to identify SSI-associated factors and evaluate the IPC intervention’s impact. Methods We conducted a retrospective cohort study in 2018 with 90-day follow-up. SSI rates were compared pre- and post-intervention.
Preintervention risk factors were assessed using Cox models. Differences in associated factor distributions were estimated. Kaplan-Meier and log-rank tests evaluated incidence, and a sensitivity analysis was stratified by American Society of Anesthesiologists (ASA) and National Nosocomial Infection Surveillance (NNIS) risk. Results Among 463 patients, overall SSI incidence was 0.52 per 1,000 patient-days. Incidence significantly declined postintervention (pre: 0.75; post: 0.26; P = .030).
Obesity (HR: 3.63; 95% CI: 1.02-12.86) and afternoon surgery (HR: 3.02; 95% CI: 1.02-8.92) were associated. High ASA, NNIS risk, and inadequate prophylaxis significantly decreased (P ' .001).
The intervention reduced SSI risk by 66% (HR: 0.34; 95% CI: 0.13-0.94; P = .037). A nonsignificant reduction was seen in high-risk strata.
Conclusions
Our study showed the impact of an IPC intervention addressing associated factors and significantly reducing SSI incidence rates.