Authors: (including presenting author): :
Fung PM(1), Lin SK(1), Sze NL(1), Ng HL(1)
Affiliation: :
(1)The Duchess of Kent Children's Hospital at Sandy Bay
Keyword 2: :
Surgical Site Infection
Keyword 3: :
Total Knee Replacement
Keyword 4: :
Joint Replacement
Keyword 5: :
Orthopaedic and Traumatology
Keyword 6: :
Nursing Care Bundle
Introduction: :
The issue was identified through Orthopaedic & Traumatology Surgical Site Infection (SSI) surveillance report in Q3 2025, which showed SSI rate of 3.7 per 100 elective total knee replacement procedures in DKCH, notably higher than Hospital Authority benchmark of 1.378. Further investigation identified several contributing factors. The average postoperative length of stay had decreased from 2.5–3 days to 1–1.5 days, which reduced in-patient observation period for wound assessment. Consequently, wound dressings were often changed prior to discharge, which conflicts with WHO guidelines recommending that surgical wounds should remain undisturbed for at least 48 hours unless leakage occurs. Besides, same day admission patients did not undergo preoperative chlorhexidine (CHG) bathing, leading to inconsistent pre-surgical skin preparation. It was also noted that patient's awareness regarding robotic pin-site wound care was limited, increasing the risk of inadequate management.
Objectives: :
This project aims to reduce SSI rate among elective total joint replacement patients to below 1.378 per 100 procedures by Q1 2026 through the implementation of a perioperative nursing care bundle. The project focuses on strengthening preoperative 4% CHG bathing compliance, standardizing robotic pin-site wound management, and reinforcing postoperative wound-care education and follow-up upon discharge, aligning with evidence-based guidelines and WHO recommendations for wound management.
Methodology: :
Structured perioperative nursing care bundle was implemented across the patient journey. Preoperatively, 4% CHG will be distributed to all joint replacement patients at pre-anaesthetic clinic, including same day admission cases who previously did not perform CHG bathing. Nurses will provide verbal instruction and an illustrated leaflet detailing proper use and timing before admission. Compliance will be documented during admission checks. Intraoperatively, dressing will be standardized as foam boarder for pin-site wounds to ensure better fixation and exudate absorption by replacing previous Tegaderm with pad, which easily loosened when soaked. Postoperatively, primary wound dressing will keep undisturbed for at least 48 hours unless increased oozing. Patients will receive standardized wound care education using illustrated leaflets before discharge. Nurse-led 48-hour post-discharge follow-up call was introduced to assess wound, reinforce education, and facilitate early escalation.
Result & Outcome: :
The project’s main goal is to reduce SSI rate to below 1.378 per 100 by Q1 2026. Additional KPIs include: ≥90% compliance with preoperative 4% CHG bathing, including same day admissions via pre-anaesthetic clinic distribution and education. ≥90% compliance in the use of standardized absorbent dressing for robotic pin-site wounds. 100% completion of standardized discharge wound care education with patient leaflet. 100% completion of 48-hour nurse-led post-discharge follow-up calls. ≥20% reduction in 30-day SSI-related readmissions. ≥90% patient satisfaction with wound care education and nursing support. Project’s success will be evaluated quantitatively by achieving a reduction in SSI rate from 3.7 to below 1.378 by Q1 2026. Other quantitative measures include achieving 100% CHG bathing compliance, 92.8% standardized pin-site dressing use, 100% completion of nurse-led follow-ups, and 100% reduction in 30-day SSI-related readmissions. Besides, 94.2% of patients expressed satisfaction with wound education and nursing support. Collectively, these outcomes demonstrated sustainable improvement in nursing quality, patient safety, and infection prevention for total joint replacement surgeries.
