Surgical site infections after total hip arthroplasty result in decreased quality of life, increased morbidity and increased health care cost. We hypothesized that the implementation of a bundle of care for total hip arthroplasty decreases the amount of surgical site infections.

In this retrospective cohort study we investigated the implementation of this bundle in a University Medical Centre and its effect on perioperative surgical site infections after total hip arthroplasty and on incidence of hypothermia.

In 2009 the bundle of care consisting of four elements was implemented in total hip arthroplasty in our hospital; (I) perioperative normothermia, (II) hair removal before surgery, (III) the use of preoperative antibiotic prophylaxis and (IV) discipline on the operation room measured by door movements. For this study we used data from January 2010 – October 2013. We measured all parameters prospectively including surgical site infections within 6 weeks postoperatively.

In the study period a total of 585 patients received a primary total hip arthroplasty. Bundle compliance improved significantly in 3.5 years from 71.7% in 2010 to 91.6% in 2013. Postoperative hypothermia decreased from 10.5% to 8.4% (non-significant) and SSI rate from 0.9% to 0.0% (non-significant).

Implementation of this bundle of care is possible in an academic tertiary referral center. A relatively cheap solution can increase patient safety in a surgical environment. Introduction of a bundle of care resulted in a non-significant reduction of hypothermia and rate of surgical site infections in total hip arthroplasty.