A Multicenter Intervention to Reduce Surgical Site Infections among Patients Undergoing Cardiac Operations and Total Joint Arthroplasty (STOP SSI Study)
Method: 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 & to bathe with chlorhexidine-gluconate (CHG) for 5 days before their operations. MRSA carriers received vancomycin & cefazolin for perioperative prophylaxis; patients who did not carry MRSA received cefazolin. MRSA/MSSA negative patients bathed with CHG the night before & 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 6/2012 & 10/2012; the last patient was entered 2/28/2014. Monthly SSI counts were analyzed using Poisson regression models (offset variable = log transformed monthly procedure counts). Bundle compliance (both healthcare worker & patient) was categorized as full, partial, or none.
Result: 20 hospitals in a national healthcare organization & located in 9 states implemented the bundle. After a 3-month phase-in period, compliance remained at 63% fully compliant & 14% partially compliant. Overall, 100 (0.35%) complex S. aureus SSIs occurred after 28,210 procedures in the pre-intervention period & 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 & by 50% (RR = 0.50; 95% CI: 0.30, 0.84) for THA/TKA. The number of months without complex S. aureusSSI increased from 2/39 (5.1%) to 6/21 (28.6%; P = 0.01).
Conclusion: A bundle that includes S. aureus screening, decolonization, & targeted perioperative prophylaxis decreased complex S. aureus SSI rates significantly.
E. Septimus, None
J. Moody, None
B. Braun, None
J. Hafner, None
M. Ward, None
J. Hickok, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product
E. Perencevich, None
D. J. Diekema, Forest Labs: Grant Investigator, Research grant
C. Richards, None
J. Perlin, None
L. A. Herwaldt, None