Pre-operative Infection Prevention “Bundle” Can Reduce Staph Surgical Site Infections, JAMA Article Says
Implementing a pre-operative infection prevention “bundle” was associated with a significant reduction in serious S. aureus surgical site infections, according to an AHRQ-funded study published in today’s Journal of the American Medical Association.
The study, led by Loreen A. Herwaldt, M.D., of the University of Iowa Carver College of Medicine, included 42,534 cardiac operations and hip and knee replacements performed in 20 Hospital Corporation of America-affiliated hospitals in nine U.S. states. The bundle included screening for S. aureus, decolonizing patients who were positive for these bacteria, and administering perioperative antibiotics according to an evidence-based protocol. Compared with serious S. aureus SSI rates seen in the pre-intervention period, rates decreased significantly among patients in the groups that fully adhered to the bundle; rates did not decrease significantly in the partially adherent or non-adherent group.
The study can be found at http://jama.jamanetwork.
Original Investigation | June 2, 2015
Association of a Bundled Intervention With Surgical Site Infections Among Patients Undergoing Cardiac, Hip, or Knee Surgery
ABSTRACT
Importance Previous studies suggested that a bundled intervention was associated with lower rates ofStaphylococcus aureus surgical site infections (SSIs) among patients having cardiac or orthopedic operations.
Objective 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.
Design, Setting, and Participants 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).
Interventions 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.
Main Outcomes and Measures The primary outcome was complex (deep incisional or organ space) S aureus SSIs. Monthly SSI counts were analyzed using Poisson regression analysis.
Results 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]).
Conclusions and Relevance 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.
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