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Surgical site infections reduced through screening and decolonization

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SAN DIEGO — An institution-wide screening and decolonization protocol for methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus can help decrease deep surgical site infections in patients undergoing primary knee and hip arthroplasty, according to a study presented here at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

As patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) are at an increased risk of surgical site infection (SSI), Scott R. Hadley, MD, and colleagues analyzed the impact of their screening and decolonization protocol on patients who underwent primary hip and knee arthroplasty between 2007 and 2009.

“Our hypothesis is that preoperative Staphylococcus surveillance and decolonization will lead to a decrease in surgical site infections and hospital-acquired MRSA infections,” Hadley said.

The protocol

Patients in the study were seen at pre-admission testing prior to undergoing primary hip or knee arthroplasty. Here, they were screened for MRSA and MSSA colonization in addition to being provided a 5-day course of nasal mupirocin and a single preoperative chlorhexidine shower.

Patients found to be colonized with MRSA received a vancomycin perioperative prophylaxis.

Patients without organisms at pre-admission testing did not receive decolonization protocols and constituted the control group. Every patient was followed for 1 year to check for postoperative infection. Surgical site infection was classified using CDC criteria.

A significant decrease

The study investigated 2,058 patients, with 1,644 undergoing the protocol and 414 entering into the control group. The investigators reported six deep (SSIs) in the control group (1.45%) and 21 SSIs in the treatment group (1.28%), with the total hip arthroplasty treatment subgroup having a lower rate of deep SSIs (1.19%) than its control group (2.38%).

Hadley noted trends toward decreased deep SSIs in the protocol treatment groups.

“Our data was underpowered, however the protocol did lead to a statistically significant decrease in the rate of hospital-wide acquired MRSA infection rates,” Hadley concluded, adding stable rates in decrease throughout the hospital system indicating “these findings are not secondary to a community MRSA rate change.”

“These results suggest that implementation of a Staphylococcus decolonization protocol in high-risk orthopedic patients may have a significant impact on postoperative infection rates,” he added.

Reference:

• Hadley SR, et al. Staphylococcus aureus decolonization protocol decreases surgical site infections. Paper 129. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.

Disclosure: Hadley has reported no relevant financial interests.

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