Impact of Preoperative Povidone Nasal Swab on the Incidence of Surgical Site Infection: An Observational Study
Michael A Edwards1, Anyull D Bohorquez Caballero1, Amy Glasgow2
1Division of Advanced GI And Bariatric Surgery, Department for the Science of Health Care Delivery, Robert D. and Patricia E. Kern Center,Mayo Clinic, Jacksonville, Florida.
Objectives:
Surgical site infections (SSIs) are the most common hospital-acquired infections in the United States, of which methicillin-resistant Staphylococcus aureu s (MRSA) accounts for 43%. Preoperative povidone-iodine nasal swab (PNS) is considered an effective and cost-saving treatment for Staphylococcus aureu s decolonization. We aim to assess the impact of preoperative PNS on SSI incidence.
Materials And Methods:
This retrospective observational study utilized elective surgical cases between January 1, 2018 and May 31, 2023, at a single academic medical center. The cohort was divided into PNS and no PNS groups. The cohort was propensity-matched, and Pearson χ 2 /Kruskal-Wallis tests were performed to compare group differences. Multivariable logistic regression was utilized to compare events between cohorts before and after matching. An alpha of <0.05 was considered significant.
Results:
A total of 45,998 (22,999 per group) matched participants were evaluated. On multivariate regression, the non-PNS treatment group was associated with an increase in hospital overall SSI occurrence (OR: 1.48, P = 0.02) but not specifically in-hospital methicillin-sensitive Staphylococcus aureus SSI, MRSA-SSI, or any 30-day SSI ( P > 0.05). Compared with PNS treatment and prophylactic antibiotics, in-hospital SSI was higher in the absence of PNS treatment (OR: 1.83, P < 0.001), antibiotic (OR: 2.63, P < 0.001), or both (OR: 2.06, P < 0.01). Compared with PNS treatment plus prophylactic antibiotic, in-hospital MRSA-SSI was only higher in the absence of antibiotic (OR: 2.92, P < 0.01) treatment.
Conclusions:
Preoperative treatment with PNS may reduce overall in-hospital SSI but has no independent impact on MRSA SSI.
Insights
Preoperative povidone-iodine nasal swab (PNS) may reduce overall surgical site infections (SSIs). However, this study found no independent impact of PNS on methicillin-resistant Staphylococcus aureus (MRSA) SSIs.
Area of Science:
- Infectious Disease
- Surgical Outcomes
- Hospital-Acquired Infections
Background:
- Surgical site infections (SSIs) are a significant concern in healthcare settings.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen contributing to SSIs.
- Preoperative nasal decolonization with povidone-iodine nasal swab (PNS) is a strategy to reduce Staphylococcus aureus colonization.
Purpose of the Study:
- To evaluate the effectiveness of preoperative povidone-iodine nasal swab (PNS) in reducing the incidence of surgical site infections (SSIs).
- To determine the specific impact of PNS on MRSA-related SSIs.
Main Methods:
- Retrospective observational study of elective surgical cases from January 2018 to May 2023.
- Propensity-matched analysis comparing patients who received PNS versus those who did not.
- Multivariable logistic regression to assess the association between PNS and SSI occurrence.
Main Results:
- The analysis included 45,998 propensity-matched participants.
- Preoperative PNS was associated with a reduced overall in-hospital SSI occurrence (OR: 1.48, P=0.02).
- PNS did not show an independent impact on MRSA-SSI or 30-day SSIs, but absence of antibiotics significantly increased MRSA-SSI risk.
Conclusions:
- Preoperative PNS may contribute to a reduction in overall in-hospital SSIs.
- PNS does not appear to have an independent effect on reducing MRSA-SSI.
- Antibiotic prophylaxis remains crucial for preventing MRSA-SSI.
More Related Videos
05:39Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
09:12Characterization of Inflammatory Responses During Intranasal Colonization with Streptococcus pneumoniae
Published on: January 17, 2014
Related Concept Videos
01:23Hand hygiene
Hand washing...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:30Epistaxis
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...