D. S. Urias1, J. Di Como1, K. Curfman1, M. Marley1, W. Carney1, D. Duke1, R. Dumire1, S. Morrissey1 1Conemaugh Memorial Medical Center,Johnstown, PA, USA
Introduction:
Surgical site infections (SSIs) are the most common hospital acquired infections (HAIs), although rare in abdominal wall hernia repair it is one of the most dreaded complications. Bundle protocols using chlorhexidine-gluconate (CHG) bath, nasal S. aureus decolonization with povidone iodine, and standard preoperative antibiotics have been proven in multiple trials to decrease SSIs. Because of these findings, we added a nasal decolonization bundle protocol to most surgical procedures with similar results. To better understand the impact of this key portion to the bundle protocol, we investigated colonization prevalence to provide insight as to the actual (practical) decolonization efficacy.
Methods:
A prospective observational study enrolling patients undergoing elective abdominal wall hernia repair with mesh. All patients were instructed to bathe with CHG the night before and morning of surgery, preoperatively a nasal culture for S. aureus was obtained from the nares, the nares were then swabbed with povidone-iodine nasal swabs, standard preoperative antibiotics were administered and the patient underwent the procedure. Postoperative nasal cultures for S. aureus were also obtained. Pre and post colonization prevalence were compared, thereby providing an estimate of the actual efficacy of our decolonization protocol in eliminating S. aureus in the nares.
Results:
To date, 80 patients have been consented and enrolled, with 54 patients completing all steps of the bundle and culture series. The study sample demographics include 91% males, mean age 59, mean BMI 29 and mean ASA was 2. The mean length of surgery was 47 minutes and the mean time from end of surgery to obtaining the post decolonization s. aureus nasal culture was 105 minutes. For our study sample, the estimated prevalence of colonization with MRSA and/or MSSA is 22.2% (12/54) pre decontamination (11 MSSA, 1 MRSA, 0 positive for both) and 9.25% (5/54) after decontamination and surgery (5 MSSA and 0 MRSA), yielding an approximate 68% decontamination efficacy.
Conclusion:
Decreasing the rate of SSIs is a task assumed by a variety of departments within the health system using numerous methods. Evidence based decontamination protocols such as the one we have implemented are being successfully used to decrease SSIs. We have used our protocol in orthopedic and neurosurgical procedures and now have successfully expanded the protocol to repairs of abdominal wall hernias with mesh. The efficacy of povidone iodine in our study population although not as high as stated in recent literature, it does provide evidence for its use in a bundle protocol to decrease SSIs.