507. Reduction in Staphylococcus aureus Surgical Site Infections (SSIs) by Nasal Application of Mupirocin and Chlorhexadine(CHG)  Baths: Report of two years’ experience
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: One RCT of preoperative topical nasal mupirocin and chlorhexadine bathing performed in the Netherlands showed a significant reduction in methicillin susceptible S aureus (MSSA) SSIs in patients undergoing major cardiothoracic and neuro surgery(Bode et al. NEJM, 2010). Because methicillin resistant S aureus (MRSA) is very rare in the Netherlands, the generalizability of this study has not led to widespread adoption of this intervention in the U.S.  Several post hoc studies of these interventions with stop time design have been published and have shown statistically significant reductions in all S.aureus SSIs. Most of these post hoc studies, however, have had only a year of follow-up data and thus they may possibly represent merely reversions to the mean. CHS is a 5 hospital system of more than 1200 beds in the Piedmont area of N.C and from 2008 through 2010, SSI infection prevention interventions emphasized hand hygiene, barrier precautions, and environmental cleaning.  There was no change, however, in overall MRSA SSIs as assessed by microbiology culture reports and clinical surveillance using NHSN definitions. 

Methods:

We report a 2 year experience after instituting PCR nasal screening and topical mupirocin and CHG baths in all nasal carriers of MSSA and MRSA scheduled for major surgery.

Beginning in 2011, preoperative PCR nasal screening for MSSA and MRSA carriage of all elective surgical patients was introduced, and nasal carriers of MSSA/MRSA received both topical nasal mupirocin BID and once  daily CHG bathing for 5 days preoperatively.

Results:

MSSA and MRSA SSI rates for 2010 before instituting this intervention were compared to SSI rates in 2011 and 2012. MSSA and MRSA SSI rates from 2011 and 2012, after the intervention were all statistically lower when compared to the SSI rates from 2010, (p<.0.001 by X2).   

Conclusion: Preoperative nasal mupirocin and CHG bathing for 5 days in nasal carriers of MSSA and MRSA statistically significantly reduces surgical site infections over a two period.

Rate of surgical site infection/ 1,000 patient-days

Year 2010

Year 2011

Year 2012

P-value

MSSA

0.48

0.20

0.19

<0.001

MRSA

0.43

0.09

0.16

<0.001

Cynthia Snider, MD, Medicine, Moses Cone Hosptial, Greensboro, NC

Disclosures:

C. Snider, None

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