Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective
Serge P Bebko1, David M Green2, Samir S Awad1
1Department of Surgery, Baylor College of Medicine, Houston, Texas2Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Importance:
Surgical site infections (SSIs), commonly caused by methicillin-resistant Staphylococcus aureus (MRSA), are associated with significant morbidity and mortality, specifically when hardware is implanted in the patient. Previously, we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients.
Objective:
To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation.
Design, Setting, And Participants:
A prospective database of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, was analyzed from October 1, 2012, to December 31, 2013. Cohort groups before and after the intervention were compared.
Interventions:
Starting in May 2013, during their preoperative visit, all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery.
Main Outcomes And Measures:
Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance. Data on demographics, comorbidities such as chronic obstructive pulmonary disease and coronary artery disease, tobacco use, alcohol use, and body mass index were also collected. Univariate analysis was performed between the 2 groups of patients. Multivariate analysis was used to identify independent predictors of SSI.
Results:
A total of 709 patients were analyzed (344 controls and 365 patients who were decolonized). Both groups were well matched with no significant differences in age, body mass index, sex, or comorbidities. All of the patients (100%) completed the MRSA decontamination protocol. The SSI rate in the intervention group was significantly lower (1.1%; 4 of 365 patients developed an SSI) than the SSI rate in the control group (3.8%; 13 of 344 patients developed an SSI) (P = .02). Multivariate logistic regression identified MRSA decontamination as an independent predictor of not developing an SSI (adjusted odds ratio, 0.24 [95% CI, 0.08-0.77]; P = .02).
Conclusions And Relevance:
Our study demonstrates that preoperative MRSA decontamination with chlorhexidine washcloths and oral rinse and intranasal povidone-iodine decreased the SSI rate by more than 50% among patients undergoing elective orthopedic surgery with hardware implantation. Universal decontamination using this low-cost protocol may be considered as an additional prevention strategy for SSIs in patients undergoing orthopedic surgery with hardware implantation and warrants further study.
Insights
A preoperative decontamination protocol significantly reduced surgical site infections (SSIs) in orthopedic surgery patients. This methicillin-resistant Staphylococcus aureus (MRSA) reduction strategy lowered SSI rates by over 50% in patients receiving implants.
Area of Science:
- Infectious Disease
- Surgical Outcomes
- Antimicrobial Resistance
Background:
- Surgical site infections (SSIs) pose significant risks, particularly in patients with implanted hardware.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen contributing to SSIs.
- Preoperative MRSA decontamination has shown promise in reducing infections.
Purpose of the Study:
- To evaluate the efficacy of a preoperative decontamination protocol in reducing SSIs.
- To assess the impact of MRSA decolonization on patients undergoing elective orthopedic surgery with hardware implantation.
Main Methods:
- Prospective analysis of patients undergoing elective orthopedic surgery with hardware implantation.
- Comparison of SSI rates in a control group versus an intervention group using chlorhexidine washcloths, oral rinse, and intranasal povidone-iodine.
- Multivariate logistic regression to identify independent predictors of SSI.
Main Results:
- The intervention group had a significantly lower SSI rate (1.1%) compared to the control group (3.8%) (P=.02).
- MRSA decontamination was identified as an independent predictor of not developing an SSI (adjusted odds ratio, 0.24).
- The protocol demonstrated a reduction in SSI rates of over 50%.
Conclusions:
- Preoperative MRSA decontamination effectively decreases SSI rates in orthopedic surgery patients with hardware.
- This low-cost protocol can be considered an additional strategy for SSI prevention.
- Further studies are warranted to validate these findings.
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