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Bundled intervention reduces S. aureus SSIs
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A bundled intervention consisting of screening, decolonization and prophylaxis may provide limited, yet meaningful results at preventing complex Staphylococcus aureus surgical site infections, according to research published in JAMA.
“Staphylococcus aureus carriage increases the risk of S. aureus surgical site infections [SSIs],” Loreen A. Herwaldt, MD, department of internal medicine, University of Iowa Hospitals and Clinics, and colleagues wrote. “The risk for these infections may be decreased by screening patients for nasal carriage of S. aureus and decolonizing carriers during the preoperative period.
“Despite this evidence … most clinicians do not screen patients for S. aureus carriage before operations and those that screen patients often screen for MRSA alone.”
Loreen A. Herwaldt
The researchers studied 38,049 patients undergoing 42,534 cardiac or orthopedic operations at 20 U.S. urban hospitals. Of these, 28,218 operations were undertaken from March 1, 2009, until intervention, and 14,316 were conducted from onset of intervention through March 31, 2014. Bundle adherence was 83%, including 39% with full adherence.
Patients whose preoperative nasal screens tested positive for MRSA or methicillin-susceptible S. aureus (MSSA) were instructed to apply mupirocin twice daily and to bathe in chlorhexidine-gluconate daily leading up to surgery. MRSA carriers were assigned vancomycin and cefazolin or cefuroxime; the other patients were given cefazolin or cefuroxime.
The researchers reported 101 S. aureus SSIs during the pre-intervention period, including MRSA (n = 45) and MSSA (n = 44). There were 29 such infections during the intervention period, including MRSA (n = 14) and MSSA (n = 13). Complex S. aureus infections during the pre-intervention period averaged 36 per 10,000 operations vs. 21 per 10,000 operations during the intervention period.
“Even though the baseline rate of complex S. aureus SSI was low, the full adherence rate was only 39%, and hospitals had implemented some bundle elements before the study began, rates of complex S. aureus SSIs decreased significantly,” the researchers wrote. “Given that approximately 400,000 cardiac operations and 1 million total joint arthroplasties are performed in the United States each year, numerous S. aureus SSIs, which can have catastrophic consequences, may be preventable.
“Our results suggest that adherence to the full bundle is important.”
Cost savings also could be significant, the investigators wrote, since each SSI creates up to $100,000 in health care costs.
In a related commentary, Preeti N. Malani, MD, MSJ, division of infectious diseases at the University of Michigan Health System, and associate editor, JAMA, wrote that study results may have deeper significance for patients.
“Although the absolute difference of 15 infections per 10,000 operations seems modest, each complex SSI prevented is clinically meaningful,” Malani wrote. “For the individual patient, development of a serious SSI after cardiac or orthopedic surgery usually translates into months of parenteral antibiotics, additional surgical procedures, and extended inpatient and subacute care facility stays. The lengthy recovery can negate any benefit provided by the original operation.” – by David Jwanier
Disclosures: Herwaldt reports no relevant financial disclosures. Please see the full study for a list of all other author’s relevant financial disclosures. Malani reports no relevant financial disclosures.
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