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Getting the drop on Staphylococcus aureus: Semiquantitative Staphylococcus aureus nasal colony reduction in
Lisa Saidel-Odes1, Rivka Yosipovich2, Vadim Benkovich3
1Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Background:
Surgical site infection (SSI) is a frequent health care-associated infection. We aimed to reduce SSI risk after joint arthroplasty and spine surgery by reducing Staphylococcus aureus colonization burden with presurgery intranasal povidone-iodine (PVP-I) application in conjunction with skin antisepsis ("the intervention").
Methods:
Retrospective case-control study; postintervention cohort versus a historical cohort. Adults who underwent joint arthroplasty or spine surgery during February 2018 through October 2021 ("post-intervention cohort") included. In the analysis cases any patient who underwent surgery and developed SSI within 90 days postsurgery, controls had no SSI. Postintervention cohort data were compared with a similar retrospective 2016 to 2017 patient cohort that did not use intranasal PVP-I.
Results:
The postintervention cohort comprised 688 consecutive patients aged 65y/o, 48.8% male, 28 cases, and 660 controls. Relatively more cases than controls had diabetes mellitus (P = .019). There was a 39.6% eradication rate of S aureus nasal colonization post intranasal PVP-I (P < .0001). SSI rate was higher in patients positive versus those negative for S aureus on a 24-hour postsurgery nasal culture (P < .0001). The deep SSI rate per 100 operations postintervention versus the historical cohort decreased for all surgical procedures.
Conclusions:
Semiquantitative S aureus nasal colony reduction using intranasal PVP-I is effective for decreasing SSI rate in joint arthroplasty and spine surgery. In patients with presurgery S aureus nasal colonization additional intranasal PVP-I postsurgery application should be considered.
Insights
Reducing Staphylococcus aureus nasal colonization with presurgery intranasal povidone-iodine (PVP-I) effectively lowers surgical site infection (SSI) risk in joint and spine surgeries. Further PVP-I application post-surgery may benefit colonized patients.
Area of Science:
- Infectious Disease
- Surgical Outcomes
- Antimicrobial Stewardship
Background:
- Surgical site infections (SSIs) are a significant healthcare-associated infection.
- Staphylococcus aureus nasal colonization is a known risk factor for SSIs.
Purpose of the Study:
- To evaluate the effectiveness of presurgery intranasal povidone-iodine (PVP-I) application in reducing SSI risk.
- To assess the impact of PVP-I on Staphylococcus aureus colonization burden.
Main Methods:
- Retrospective case-control study comparing a postintervention cohort with a historical cohort.
- Adults undergoing joint arthroplasty or spine surgery were included.
- Intervention involved presurgery intranasal PVP-I and skin antisepsis.
Main Results:
- A 39.6% eradication rate of S aureus nasal colonization was observed post-PVP-I.
- SSI rates decreased in the postintervention cohort compared to the historical cohort.
- Deep SSI rates were significantly reduced across all procedures.
Conclusions:
- Intranasal PVP-I effectively reduces S aureus nasal colonization, thereby decreasing SSI rates in orthopedic and spine surgery.
- Consideration of postsurgery intranasal PVP-I is recommended for patients with presurgery S aureus colonization.
