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LB-9A Multicenter Intervention to Reduce Surgical Site Infections among Patients Undergoing Cardiac Operations and Total Joint Arthroplasty (STOP SSI Study)
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LB-9A Multicenter Intervention to Reduce Surgical Site Infections among Patients Undergoing Cardiac Operations and Total Joint Arthroplasty (STOP SSI Study)

Marin Schweizer, Hsiu-Yin Chiang, Edward Septimus, Julia Moody, Barbara Braun, Joanne Hafner, Melissa Ward, Jason Hickok, Eli Perencevich, Daniel J Diekema, …
Open forum infectious diseases, Vol.1(suppl_1), pp.S69-S69
12/01/2014
DOI: 10.1093/ofid/ofu083.09
url
https://doi.org/10.1093/ofid/ofu083.09View
Published (Version of record) Open Access

Abstract

Background. Our recent meta-analysis found that a bundled intervention can reduce rates of S. aureus surgical site infections (SSIs) among patients having cardiac operations (CO) or total hip (THA) or knee (TKA) arthroplasties. The bundle has not been studied in a multicenter trial. Methods. We performed a multicenter quasi-experimental study of patients having CO or THA/TKA. Patients whose preoperative nares screens were positive for MRSA or MSSA were asked to apply mupirocin intranasally twice daily for 5 days and to bathe with chlorhexidine-gluconate (CHG) for 5 days before their operations. MRSA carriers received vancomycin and cefazolin for perioperative prophylaxis; patients who did not carry MRSA received cefazolin. MRSA/MSSA negative patients bathed with CHG the night before and morning of surgery. Patients were treated as MRSA-positive if screening results were unknown (e.g., emergency operations). We collected 39 months of pre-intervention data. The primary outcome was complex (deep incisional or organ space) S. aureus SSI as defined by CDC. Rolling implementation began between June 2012 and October 2012; the last patient was entered February 28, 2014. Monthly SSI counts were analyzed using Poisson regression models (offset variable = log transformed monthly procedure counts). Bundle compliance (both healthcare worker and patient) was categorized as full, partial, or none. Results. 20 hospitals in a national healthcare organization and located in 9 states implemented the bundle. After a 3-month phase-in period, compliance remained at 63% fully compliant and 14% partially compliant. Overall, 100 (0.35%) complex S. aureus SSIs occurred after 28,210 procedures in the pre-intervention period and 28 (0.20%) occurred after 13,683 procedures in the intervention period. The overall rate of complex S. aureus SSIs decreased by 39% (relative risk [RR] = 0.61; 95% CI: 0.41, 0.91). The rate of complex S. aureus SSIs decreased by 9% (RR = 0.91; 95% CI: 0.49, 1.71) for CO and by 50% (RR = 0.50; 95% CI: 0.30, 0.84) for THA/TKA. The number of months without complex S. aureus SSI increased from 2/39 (5.1%) to 6/21 (28.6%; P = 0.01). Conclusions. A bundle that includes S. aureus screening, decolonization, and targeted perioperative prophylaxis decreased complex S. aureus SSI rates significantly.

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