Program Schedule

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

Session: Oral Abstract Session: Late Breaker Oral Abstracts
Saturday, October 11, 2014: 11:50 AM
Room: The Pennsylvania Convention Center: 105-AB
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.

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.

Marin Schweizer, PhD1, Hsiu-Yin Chiang, PhD, MS1, Edward Septimus, MD, FIDSA, FSHEA2, Julia Moody, MS2, Barbara Braun, PhD3, Joanne Hafner, RN, MS4, Melissa Ward, MS5, Jason Hickok, RN, MBA2, Eli Perencevich, MD, MS, FIDSA, FSHEA5, Daniel J. Diekema, MD, FIDSA, FSHEA6, Cheryl Richards, BS, RHIA4, Jonathan Perlin, MD, PhD, MSHA, FACP, FACMI2 and Loreen a. Herwaldt, MD, FIDSA, FSHEA1, (1)Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (2)Clinical Services Group, HCA Inc, Nashville, TN, (3)Health Services Research, The Joint Commission, Oakbrook Terrace, IL, (4)The Joint Commission, Oakbrook Terrace, IL, (5)Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (6)University of Iowa, Carver College of Medicine, Iowa City, IA


M. Schweizer, None

H. Y. Chiang, None

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

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