Moreno Medical Center Case study-Nursing Process Improvement Research

Moreno Medical Center Case study-Nursing Process Improvement Research

There is a need for process improvement at the Veteran Administration Medical Center to reduce cases of post infections following total knee arthroplasty. Currently, the use of antibiotic prophylaxis is recommended following a total knee arthroplasty. Numerous studies have shown the use of prophylaxis antibiotic is the most efficient method of reducing post infections in total knee arthroplasty (Kalore, Gioe, & Singh, 2011). In particular, the addition of prophylaxis in the irrigation solution has been found to be more efficient in reducing post infection in total knee arthroplasty. The use of antibiotic-laden cement in reducing post infections is discouraged as the method is ineffective. Use of chlorhexidine is also being encouraged since it gives better results compared to the traditional povidone-iodine in surgical field treatment. Chlorhexidine is considered a better sterilizer in surgical field treatment.

There is greater need to control the hospital environment where the surgical procedure occurs.  Research indicates that the operating room environment also determines the incidences of post infection in total knee arthroplasty (Kalore, Gioe, & Singh, 2011).  As such, control of the operating room environment is crucial. The number of individuals in the surgical room should be minimal to reduce risks of post infection. Leaving and reentering the room should also be restricted. The hospital can also consider using devices such as laminar flow or ultraviolet light to reduce infection rates during operation.

The identified processes of improvement are critical in total knee arthroplasty for our veterans. Post infections in total knee arthroplasty are often difficult to treat or even diagnose. Diagnosis is a complex process which often involves bone scans, synovial fluid examinations, radiography, histology, and other procedures which bring other complications. It is thus important to ensure that proper care is taken to avoid a post infection following a total knee arthroplasty. 


Kalore, N. V., Gioe, T. J., & Singh, J. A. (2011). Diagnosis and Management of Infected Total    Knee Arthroplasty. The Open Orthopedics Journal5, 86–91.


Nursing Leadership