When Protocols Fail Due to Lack of Adherence: Increase in Hais in Hip Surgeries With Implants

In 2022, the surgical site infection (SSI) rate after hip surgeries with implants was 11%. To address this, a bundle of six preventive measures was implemented, reducing SSI to 0.8% in 2024. However, in early 2025, the rate increased again to 12%. The objective was to evaluate the relationship between failures in adherence to the preventive bundle and the increase in SSI in hip surgeries with implants. A retrospective cohort study conducted at a single center between January 2022 and March 2025, involving patients undergoing hip surgeries with implants. SSI was defined according to Centers for Disease Control and Prevention (CDC) criteria. From September 2024 onward, a compliance assessment system was implemented to verify adherence to SSI prevention bundle items through sampling. Additionally, other preventive and risk behaviors during surgery were evaluated using a 26-item questionnaire. Between September 2024 and March 2025, 66 surgical procedures were audited. This sample included not only hip arthrodesis but also other orthopedic and general surgeries, all assessed for compliance with SSI prevention measures. A significant increase in non-compliance with SSI preventive measures was observed in late 2024 and early 2025. Non-compliance increased from 78% between September 2024 and January 2025 to 100% in February and March 2025. Univariate analysis of potential SSI risk factors comparing 2024 and 2025 data identified no significant associations. Correlation between non-compliance rate and SSI incidence was the only factor that could explain the observed infection peak. Consequently, the Infection Control Service met with surgeons to present findings and emphasize the urgent need to improve adherence to preventive measures. Despite study limitations, the increase in SSI coincided with increased non-adherence to preventive measures, without other identifiable risk factors. These results reinforce the importance of consistent adherence to prevention strategies to reduce SSI in hip surgeries with implants. Ongoing evaluation aims to better understand contributing factors and optimize prevention strategies.