Preoperative decolonization to reduce infections in urgent lower extremity repairs
Medical implants and surgical site infections (SSIs) can be a burden on both patients and healthcare systems with a significant rise in morbidity, mortality and costs. Preoperatively, our practice of a chlorohexidine gluconate (CHG) washcloth bath or solution shower was supplemented with nasal painting using povidone-iodine skin and nasal antiseptic (PI-SNA). We sought to measure the effectiveness in reducing SSIs in patients undergoing repair of lower extremity fractures.
A retrospective review of trauma patients undergoing orthopedic operations conducted at Conemaugh Memorial Medical Center from 10/1/2012 through 9/30/2016. The intervention period was 10/1/2014 to 9/30/2016 which included the addition of nasal painting with PI-SNA preoperatively. All patients were followed for 1 year prior to January 2013 and 30 or 90 days thereafter for the development of a SSI.
The pre-intervention group consisted of 930 cases with a 1.1% infection rate (10 SSIs). The intervention group consisted of 962 cases with a 0.2% infection rate (2 SSIs). This observed difference was statistically significant (P = 0.020).
This retrospective review of a methicillin-resistant Staphylococcus aureus decolonization protocol using CHG bath/shower and PI-SNA nasal painting revealed a significant decrease in the infection rate of patients undergoing lower extremity fracture repairs. We recommend its use without contraindications, but recognize that additional investigations are necessary.
KeywordsMRSA Fractures Surgical site infection Trauma Povidone-iodine Decolonization
We thank Lisa Hoegg RN, BSN, CIC, CPHQ and the Department of Infection Prevention for collecting data and championing the implementation and adherence of the protocol.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
Daniel S. Urias, Merin Varghese, Thomas Simunich, Shawna Morrissey and Russell Dumire have no conflict of interest to declare.
Informed consent was not obtained as this was a retrospective study and only minimal personal health information (PHI) was collected. Following completion of data extraction, the data were de-identified with no link remaining to any PHI, and each case was randomly assigned a randomly generated study subject identification number.
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