Implementation of Staphylococcus aureus decolonization in cardiac surgery

Area of Science:

• Implementation Science
• Infectious Disease Prevention
• Cardiac Surgery

Background:

• Guideline-recommended Staphylococcus aureus (SA) screening and decolonization is crucial for preventing surgical site infections in cardiac surgery.
• Implementation of these protocols can face significant logistical and systemic challenges.

Purpose of the Study:

• To formally assess the barriers and facilitators associated with implementing SA screening and decolonization in cardiac surgery patients.
• To identify areas for improvement and ensure successful integration into standard care.

Main Methods:

• A mixed-methods approach was used, combining focus group interviews informed by the Consolidated Framework for Implementation Research with quantitative data collection on screening and decolonization uptake.
• Intervention initiation was in November 2022, with assessments at 6 months and 1 year post-implementation.
• Regular adjustments were made to address identified barriers.

Main Results:

• High screening rates were achieved: 95% for inpatients and 91% for outpatients considered for cardiac surgery.
• Decolonization rates improved over time, particularly for inpatients (50% to 67%).
• Key barriers included delays in screening results, challenges meeting timelines, and staffing turnover.

Conclusions:

• SA screening and decolonization was successfully implemented as standard care in cardiac surgery using an implementation science framework.
• Engaging stakeholders and adaptive management were key to developing a sustainable program.
• Ongoing adjustments aim to further increase and sustain decolonization uptake.