Table 2 Timeline of the Safe Hands project (italic) and changes in standard practices

1 Baseline

Q1-2

Systematic collection of outcome data and related variable after hip fracture surgery

Q 3–4

Introduction of the Safe Hands project (ClinicalTrials.gov ID: NCT02983136) to secure leadership commitment to infection prevention in surgery

A new routine promoting early assessment by the consulting infectious diseases specialist in Staphylococcus aureus bacteraemia was introduced

2 Intervention

Q1-2

The Safe Hands project was launched in the OR

Q3-4

A new routine was implemented that formalised the practice that junior physicians in training should receive support from a senior surgeon to avoid prolonged surgical time for hip fracture surgery. The aim was to create a culture where it would be easy and appropriate to ask for help from a senior

3 Intervention

Q1-2

Antibiotic rounds twice weekly led by a consulting infectious diseases specialist were introduced on the geriatric wards with the aim of promoting sound antibiotic use, e.g. reducing the number of prophylaxis-resistant bacterial strains on the wards

Accessibility to the consulting infectious diseases specialist was increased from two to four days a week for bedside assessments

The preoperative shower routine consisting of a double shower with 4% chlorhexidine gluconate (CHX) was changed from two showers before surgery to one shower before surgery^a

If the patient had to wait for surgery for more than 48 h after the first shower, an additional CHX treatment was carried out

Expanding the Safe Hands project; a catheter-related urinary tract infection prevention strategy (Safe Bladder) was developed

Q3-4

Safe Bladder was implemented in the full care pathway ER, OR, PACU and the geriatric wards

4. Post-intervention

Q1-2

Q 3–4

5 Post-intervention

Q1-2

The antibiotic rounds led by a consulting infectious diseases specialist were reduced from twice to once weekly

Q3-4