1. Personalutbildning Skriv ämne här How to reduce infection rate in primary hip and knee replacement surgery Piteå Älvdals Hospital Sweden

2. Problem Goals Infection after surgery places demands on medical resources and is expensive as well as causing suffering for the patient To reduce the frequency of deep infections after primary hip and knee replacements to <0,5 % and superficial infections to < 5 %

3. Changes in nursing care: Basic hygiene rules Basic clothing rules For work with patients, protective coats of cloth were exchanged for plastic aprons More automatic hand alcohol cleansing units installed Purchase of UV lamp to check effect of alcohol cleansing Check that the patients have been showered twice with Descutan before operation All staff were given regular information and training in hygiene and dressing Measurement follow- ups were regularly reported

4. Clock on the wall Tougher clothing rules for anaesthesia personal Surgical caps and masks 20-second rule One sterile package instead of 35 Iodine drape over the operation site

5. Post operation : Wound dressing with 8 layers of Aquacel on primary hip replacement Aquacel Ag for risk category patients: insulin treated diabetics, RA patients treated with immunosuppressive drugs, ASA over 3, psoriasis and other skin diseases Training of all staff in sterile dressing techniques Basic hygiene rules Basic clothing rules Patient-specific mobile baskets for bedclothes

6. Measurement

7. Every person who meets the patient must be educated and apply the new hygiene routines Regular measurement of compliance with basic hygiene and clothing rules The changes were implemented through the provision of information, oral and written, and regular training sessions All staff around the patient are involved in the improvment process There was moderate resistance to the changes, but information and encouragement have enabled us to solve the problems and achieve positive results Occurrence of deep and superficial infections were measured by contacting all patients after four weeks and checking the journal after four months