Forgetfulness among top barriers to SSI preventive measures
Click Here to Manage Email Alerts
A patient survey indicated that forgetfulness was one of the top barriers to adherence to mupirocin and chlorhexidine gluconate bathing — both prescribed to prevent surgical site infections following total joint arthroplasty.
“In our previous research, we found it was hard to look in the medical record data and really know if patients were using the products that were sent home, so we decided to ask patients directly,” Stacey Hockett Sherlock, MAA, a qualitative analyst at the Iowa City VA Health Care System, told Healio. “This study was motivated by seeking to understand factors that might impact patient adherence with an intervention to prevent surgical site infections.”
Sherlock and colleagues assessed patient adherence with mupirocin and chlorhexidine gluconate (CHG) and characterized factors associated with improved patient adherence. They tested 286 patients who underwent total joint arthroplasty for Streptococcus aureus nasal carriage during preoperative clinic visits.
The researchers prescribed 17 S. aureus carriers nasal mupirocin ointment to use twice daily and CHG soap to use daily 5 days before surgery. Non-S. aureus carriers were given CHG soap to use the day before and morning of surgery. Then then surveyed patients regarding adherence the morning after surgery.
Overall, 60 patients (77.9%) reported full adherence based on their S. aureus carriage status, with all but one patient recalling having received CHG soap (98.7%). Among the 76 patients who recalled receiving CHG soap, 65 patients (85.5%) used CHG as prescribed. Fifty-nine patients who were not S. aureus carriers recalled receiving CHG soap, and 53 (89.8%) used CHG for 2 days as prescribed, whereas 12 of the 17 S. aureus carriers (70.5%) were fully adherent with the 5-day regimen.
According to the patient survey, 94.7% recalled receiving instructions on CHG use. Those who received CHG from the hospital pharmacy were significantly more likely to be fully adherent with CHG bathing compared with patients who received CHG through the mail or a different method. Barriers to patient adherence with CHG bathing included forgetfulness (n = 2), difficulty with daily bathing (n = 2), having a side effect including burning, tight, itchy or dry skin or allergic reaction and not having enough product.
Of the 17 patients who recalled receiving a mupirocin prescription, nine (52.9%) used mupirocin twice a day for 5 days. All 17 patients remembered receiving instructions on how to use mupirocin. However, younger patients and patients with incomes greater than $25,000 per year were significantly more likely to be fully adherent with mupirocin. According to the study, forgetfulness was the only barrier reported for mupirocin use.
“While an evidence-based intervention may look simple on paper, it is important to evaluate real-world acceptability and adherence in order to understand the potential effectiveness of an intervention in practice,” Sherlock said. “If an intervention requires a high patient burden to remember to self-administer medications, there may be unintended nonadherence to the protocol.”
To combat this, Sherlock said patients may need to be assisted in using medications correctly, such as with reminders or adapted instructions, or that decolonization interventions may need to be simplified by replacing mupirocin with a day-of-surgery decolonizing agent that does not rely on patient adherence.
Collapse
Read more about
Click Here to Manage Email Alerts