D. S. Urias1, S. Morrissey1, R. Dumire1 1Conemaugh Memorial Medical Center,Johnstown, PA, USA
Introduction:
Medical implant associated surgical site infections (SSIs) are a heavy burden on patients and the healthcare system, with increased costs and significant rise in morbidity and mortality. Previously, our practice had been either bathing patients with 2% chlorohexadine gluconate (CHG) wash cloth or 4% CHG solution shower the night before and morning of surgery. We implemented evidence based nasal painting with povidone-iodine to our protocol and sought to measure the effectiveness in reducing SSIs in patients who underwent elective or emergent repair of lower extremity fractures.
Methods:
A retrospective review of patients undergoing elective or emergent orthopedic operations will continue to be conducted at Duke Life Point-Conemaugh Memorial Medical Center in Johnstown, PA from 10/1/2012 through 9/30/2016. The intervention period will extend from 10/1/2014 to 9/30/2016 and included the addition of povidone-iodine nasal swabbing of each nares preoperatively. Per standard surveillance, all patients were followed for 30 days postoperatively for the development of a SSI. Patient demographics were collected including: injury, history of diabetes, chronic obstructive pulmonary disease, alcoholism, and smoking.
Results:
The pre-intervention group consisted of 933 cases over two years with a 1.2% infection rate (1.7% year one and 0.7% year two), 11 total SSIs, 10 after emergent procedures. The post-intervention group consisted of 484 cases over 1 year (10/1/2014 to 9/30/2015) with zero infections. Using the z-test for two independent proportions, a statistically significant difference was found overall pre vs. post (P = .0164). When pre was compared to post, a statistically significant difference was seen between post and pre year one (P = 0.00424) but not two (P = 0.0735) with a Bonferroni corrected alpha. Patients were well-matched on sex, age, ASA score, and surgical procedure duration.
Conclusion:
This retrospective review of an evidence based MRSA decontamination protocol with CHG wash cloths or solution shower and povidone iodine nasal painting successfully contributed to the decrease of the infection rate in patients undergoing elective and emergent repair of lower extremity fractures. Additional investigations into widespread use of decolonization of MRSA in the nares is necessary; however, based on published studies and our experience we recommend its use in patients without contraindications.