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Staphylococcus aureus Decolonization Protocol Decreases Surgical Site Infections for Total Joint Replacement
Scott Hadley1, Igor Immerman, Lorraine Hutzler
1NYU-Hospital for Joint Diseases, 301 East 17th Street New York, NY 10003, USA.
Arthritis
|November 3, 2011
Summary
Implementing a protocol for Staphylococcus screening and decolonization, including nasal mupirocin and chlorhexidine washes, showed a positive trend in reducing deep surgical site infections in joint replacement patients.
Area of Science:
- Infectious Disease
- Surgical Infection Prevention
- Microbiology
Background:
- Deep surgical site infections (SSIs) are a significant complication following primary knee and hip arthroplasties.
- Methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) are common pathogens contributing to SSIs.
- Effective screening and decolonization strategies are crucial for preventing SSIs in orthopedic surgery.
Purpose of the Study:
- To evaluate the impact of an institution-wide protocol for Staphylococcus screening and decolonization on deep SSI rates.
- To assess the efficacy of nasal mupirocin, chlorhexidine showers, and targeted vancomycin prophylaxis in reducing SSIs.
- To compare SSI rates between patients undergoing arthroplasty with and without the implemented protocol.
Main Methods:
- A prospective study involving 2058 patients undergoing primary knee or hip arthroplasty.
- Treatment group (1644 patients): Preoperative admission testing (PAT) for MSSA/MRSA, 5-day nasal mupirocin, chlorhexidine shower, and vancomycin for MRSA carriers.
- Control group (414 patients): Standard perioperative antibiotics (Ancef or Clindamycin) without specific screening or decolonization.
Main Results:
- The treatment group experienced 21 deep infections (1.28%), while the control group had 6 deep infections (1.45%).
- This represents a 13% decrease in deep SSIs in the treatment group compared to the control group (P = .809).
- The observed reduction, though not statistically significant, indicated a positive trend favoring the screening and decolonization protocol.
Conclusions:
- The implemented Staphylococcus screening and decolonization protocol demonstrated a favorable trend in reducing deep SSIs after joint arthroplasty.
- Targeted interventions, including nasal mupirocin and vancomycin for MRSA carriers, show promise in enhancing surgical site infection prevention.
- Further investigation and potentially larger studies are warranted to confirm the statistical significance and clinical impact of such protocols.
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