Background: Surgical site infections (SSI) caused by S. aureus continue to be an important cause of morbidity and mortality among patients undergoing cardiothoracic surgery. About 20% of adults are colonized by S. aureus. They are more likely to develop SSIs that those not colonized.
There is evidence that decolonization before surgery decreases SSIs. Furthermore, use of prophylactic vancomycin among patients colonized by MRSA helps decrease the rate of MRSA SSIs.
Methods: A S. aureus prevention surgical checklist, consisting of MRSA and MSSA screening, decolonization for all positive during the pre-operative clinic visit, and vancomycin prophylaxis for MRSA positive, was implemented at the South Texas Veterans Health Care System among cardiothoracic surgery patients.
We met with a multidisciplinary group including cardiothoracic surgeons, nurses and nurse practitioners, microbiology physicians, infection preventionists, and infectious diseases physicians to discuss and implement this checklist.
Checklist compliance was monitored by infection prevention and presented at the surgery meetings, infection control committees, and antimicrobial stewardship subcommittees, and reported to leadership.
Results: Pre-intervention S. aureus screening increased from 5% (8/144) to 95% (120/126). During post-intervention, there was a significant decrease in the number of vancomycin doses used, decreasing from 36% (53/144) to 14% (18/126), p < .001. There was no increase of infection rate with lower vancomycin use.
Average SSI Rate
Conclusion: Prior to this projects implementation, the use of vancomycin for the majority of cardiothoracic surgery patients led to concerns regarding antibiotic resistance and effective prophylaxis. Screening methods and antibiotic regimens were variable depending on the surgeons preference.
Proper use of the checklist was shown to lead to decreased use of vancomycin, with the potential to decrease SSIs by improving decolonization and proper antibiotic prophylaxis.
The checklist is generalizable to other invasive surgical procedures, and we are expanding institutional use of the checklist to include neurosurgery with implants.
Va HSR&D grant:
C. Tierney, None
M. Hibner, None
L. Leykum, None