Implementation of Staphylococcus aureus decolonization in cardiac surgery

Staphylococcus aureus (SA) screening and decolonization is a guideline-recommended treatment for the prevention of surgical site infections in cardiac surgery. This study aimed to formally assess the barriers and facilitators associated with its implementation.

Targeted SA screening and decolonization started at our institution in November 2022. To assess barriers and facilitators to implementation, we conducted focus group interviews informed by the Consolidated Framework for Implementation Research at approximately 6 months after initiation of the intervention. We also regularly collected quantitative data on missed screening and/or decolonization to address gaps in uptake. This was reviewed at 6-month and 1-year time points. Adjustments to implementation were regularly made to address barriers.

At 1 year, 563 nonurgent inpatients and 232 outpatients were consulted to cardiac surgery. Ninety-five percent of the inpatients and 91% of the outpatients considered for cardiac surgery were screened appropriately. Of the patients accepted for cardiac surgery, 50% of positive inpatients underwent decolonization in the first 6 months prior to focus groups compared to 67% in the subsequent 6 months. For outpatients, 77% were decolonized in the first 6 months, compared to 79% in the subsequent 6 months. Major barriers to implementation included delays in receiving screening results, difficulty meeting screening and decolonization timelines, and staffing turnover.

SA screening and decolonization was successfully implemented as a standard of care at our institution with the aid of an implementation science framework. By engaging care partners and healthcare staff throughout the implementation process and regularly addressing barriers, we developed a sustainable SA screening and decolonization program. Adjustments are ongoing to increase and sustain decolonization uptake.