Logo image
Back
Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery
Journal article   Open access   Peer reviewed

Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery

Marin L Schweizer, Hsiu-Yin Chiang, Edward Septimus, Julia Moody, Barbara Braun, Joanne Hafner, Melissa A Ward, Jason Hickok, Eli N Perencevich, Daniel J Diekema, …
JAMA, Vol.313(21), pp.2162-2171
06/02/2015
DOI: 10.1001/jama.2015.5387
PMID: 26034956
url
https://doi.org/10.1001/jama.2015.5387View
Published (Version of record) Open Access

Abstract

Previous studies suggested that a bundled intervention was associated with lower rates of Staphylococcus aureus surgical site infections (SSIs) among patients having cardiac or orthopedic operations. To evaluate whether the implementation of an evidence-based bundle is associated with a lower risk of S. aureus SSIs in patients undergoing cardiac operations or hip or knee arthroplasties. Twenty hospitals in 9 US states participated in this pragmatic study; rates of SSIs were collected for a median of 39 months (range, 39-43) during the preintervention period (March 1, 2009, to intervention) and a median of 21 months (range, 14-22) during the intervention period (from intervention start through March 31, 2014). Patients whose preoperative nares screens were positive for methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA) were asked to apply mupirocin intranasally twice daily for up to 5 days and to bathe daily with chlorhexidine-gluconate (CHG) for up to 5 days before their operations. MRSA carriers received vancomycin and cefazolin or cefuroxime for perioperative prophylaxis; all others received cefazolin or cefuroxime. Patients who were MRSA-negative and MSSA-negative bathed with CHG the night before and morning of their operations. Patients were treated as MRSA-positive if screening results were unknown. The primary outcome was complex (deep incisional or organ space) S. aureus SSIs. Monthly SSI counts were analyzed using Poisson regression analysis. After a 3-month phase-in period, bundle adherence was 83% (39% full adherence; 44% partial adherence). Overall, 101 complex S. aureus SSIs occurred after 28,218 operations during the preintervention period and 29 occurred after 14,316 operations during the intervention period (mean rate per 10,000 operations, 36 for preintervention period vs 21 for intervention period, difference, -15 [95% CI, -35 to -2]; rate ratio [RR], 0.58 [95% CI, 0.37 to 0.92]). The rates of complex S. aureus SSIs decreased for hip or knee arthroplasties (difference per 10,000 operations, -17 [95% CI, -39 to 0]; RR, 0.48 [95% CI, 0.29 to 0.80]) and for cardiac operations (difference per 10,000 operations, -6 [95% CI, -48 to 8]; RR, 0.86 [95% CI, 0.47 to 1.57]). In this multicenter study, a bundle comprising S. aureus screening, decolonization, and targeted prophylaxis was associated with a modest, statistically significant decrease in complex S. aureus SSIs.
 Humans Middle Aged Mupirocin - administration & dosage Male Antibiotic Prophylaxis Cefuroxime - therapeutic use Young Adult Cardiac Surgical Procedures Aged, 80 and over Adult Arthroplasty, Replacement, Knee Female Chlorhexidine - administration & dosage Drug Therapy, Combination Cefazolin - therapeutic use Staphylococcus aureus - isolation & purification Arthroplasty, Replacement, Hip Administration, Intranasal Surgical Wound Infection - prevention & control Chlorhexidine - analogs & derivatives Vancomycin - therapeutic use Adolescent Staphylococcal Infections - prevention & control Aged Methicillin-Resistant Staphylococcus aureus - isolation & purification Nose - microbiology

Details

Metrics

28 Record Views
220 Times Cited - Web of Science
Logo image