Interior Health (IH) announced Friday that on-hold orthopedic surgeries at the Trail hospital will resume Monday.
Scheduled hip and knee total joint replacements were halted at Kootenay Boundary Regional Hospital 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.
Six patients were confirmed with various strains of infection post op, prompting IH to launch 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 re-booked as priority cases.
The review involved Interior Health and external specialists in infection prevention, control and surgical practices.
A “Surgical Quality Working Group,” which includes orthopedic surgeons, was established early in the review process to review 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 in the ORs.
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.
Finally, an internal review by IH infection prevention and control practitioners highlighted current standards and best practices for preventing surgical site infections.