Multifaceted intervention can help decrease SSIs, study finds

A presurgical intervention that includes screening for Staphylococcus aureus and administering antibiotics based on those screening results was associated with a reduction in S. aureus surgical site infections, according to a study published in JAMA.

Twenty hospitals in nine states participated in the study, which involved implementing an evidence-based bundle for patients undergoing cardiac operations or hip or knee replacement or reconstruction. Data was collected for a median of 39 months pre-intervention, and for a median of 21 months during the intervention period.

Clinicians would swab patients for methicillin-resistant and methicillin-susceptible S. aureus and have patients who tested positive apply an antibiotic in their nose twice daily for up to five days and also bathe daily with chlorhexidine-gluconate for up to five days before their operations.

Overall, the pre-intervention period had an average rate of complex S. aureus SSIs was 36 per 10,000 operations, and the intervention period had an average rate of 21 per 10,000 operations. Complex S. aureus rates decreased for both hip or knee arthroplasties and for cardiac operations.

"Given that approximately 400,000 cardiac operations and 1 million total join arthroplasties are performed in the United States each year, numerous S. aureus SSIs, which can have catastrophic consequences, may be preventable," the researchers wrote. "Moreover, one SSI adds from $13,000 to $100,000 to the cost of healthcare. Thus, implementation of this bundle might reduce patient morbidity and the costs of care substantially."

In an accompanying editorial in JAMA, however, one researcher noted that decolonizing MRSA patients should just be one precaution among many when it comes to preventing SSIs.

"Although S. aureus remains the principal pathogen in terms of prevalence and associated morbidity, many other organisms also cause SSIs," wrote Preeti Malani, MD, of the University of Michigan Health System in Ann Arbor. "As such, decolonization of MSSA and MRSA can be only one aspect of SSI prevention."

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