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The Steiros Algorithm®
Reduced Orthopedic Surgical Site Infections Rates and Associated Costs

by Paul A. Watson, MD, MS(a), Luke R. Watson, MD(b), and Alfonso
Torress-Cook, DrPH(b)

a = Lakeside Orthopedics, Omaha, NE
b = Pacific Hospital of Long Beach, Long Beach, CA

Paper #1679, submitted for presentation at
SHEA Decennial International Conference on Healthcare-Associated Infections
March 18-22 2010

AAOS 2010 Annual Meeting Poster Presentation

Background

Control of hospital-acquired surgical site infections (SSI) and their costs are imperative for the safety of our

patients. As infection control practitioners we strive to have the lowest infection rate possible for all surgical

procedures. An easily instituted whole hospital infection control algorithm would greatly enhance patient care

and lower hospital costs.

Objective

This study evaluates the effects of a novel environmental

cleaning and decontamination algorithm (Steiros

Algorithm®) on spinal fusion (SF), total hip (THA) and total

knee arthroplasty (TKA) SSI rates.

Methods

The hospital's procedure and infection rate database was

reviewed for all total hip arthroplasty (THA), total knee

arthroplasty (TKA) and spinal fusion (SF) procedures from

2005 - 2008 at one institution.

A standardized SSI surveillance program was used

throughout the study period. We calculated and compared

the SSI rate performed before and after the Steiros

Algorithm® was instituted on January 1st 2006.

The overall infection and methicillin resistant

Staphylococcus Aureus (MRSA) rates were reviewed for

each type of procedure. Previously published estimated

costs for these SSI were used for analysis (TKA and SF

infections cost $27,000 and $12,447 respectively).

Results

Overall, the SSI rates decreased 58% (23/750 to

35/2752)

(P=0.0017) and the MRSA rate decreased 82% (9/750 to

6/2752)(P=0.0024). There were no THA infections during the

study period.

The TKA overall infection rate decreased 68% (11/331 to

10/935)(P=0.01) and the MRSA rate decreased 82% (4/331 to

2/935)(P= 0.044).

The SF infection rate and MRSA rate decreased 66% (12/290

to 25/1749) (P=0.0036) and 83% (5/290 to 9/1749)(P=0.038)

respectively.

Due to the reduction in SSIs, the hospital saved $907,971

over a 3 year period.

Conclusions

We believe that the Steiros Algorithm®, a global

environmental cleaning protocol for hospitals, is a very safe

and effective way to reduce orthopedic SSI and hospital costs

by eliminating bacteria from the hospital and patient

environment.

In this retrospective review, the institution of the Steiros

Infection Control Algorithm dramatically reduced the overall

and MRSA specific orthopedic SSI rates.

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