1025Impact of Nasal Decontamination with Nasal Iodine as part of a Preoperative Surgical Site Infection (SSI) Prevention Bundle in Orthopedic Implant Surgeries

Abstract

Nasal iodine as a bundled approach can be a rapid and effective method for prevention of all Surgical Site Infections (SSIs) and also S. aureus SSIs in orthopedic implant surgeries by decontamination of the nares. The individual effect of nasal iodine in reduction of SSI in orthopedic surgeries will need to be determined in future studies, but this offers an alternative to screening and decolonization with mupirocin. Conclusion  Staphylococcus aureus is the leading cause of surgical site infections. 80 percent of S. aureus infections are caused by the patients own nasal flora. Nasal iodine (3MTM Skin and Nasal Antiseptic ) is effective for 1 to 12 hours post application and can be used for decolonization (reduces organism burden by 99.5% in the nares) Nasal iodine application is quick and generally done as a single application just prior to surgery. Background This study was conducted at Detroit Receiving hospital starting March, 2013.  This approach was used as part of a bundle which included perioperative CHG bathing and addition of vancomycin prophylaxis.  Infection rates for knee and hip surgeries were collected by infection control personnel during routine surveillance for surgical site infections. Infection rates were compared 1 year before and 1 year after intervention. Methods Results Background: Nasal carriage of Staphylococcus aureus (SA) has been shown to be an independent risk factor for SA surgical site infections (SSI), with a SSI rate 2-9 times higher in carriers. Decolonization with nasal mupirocin is often recommended for carriers or high risk individuals, however this process requires preoperative screening and patient compliance with application days prior to surgery. Nasal decontamination with nasal iodine just prior to surgery offers a rapid method of decreasing the nasal burden of SA in high risk joint implant surgeries. Methods: Nasal decontamination with nasal iodine (3MTM Skin and Nasal Antiseptic) of all patients undergoing hip and knee prosthetic joint replacement was implemented pre-operatively since March 2013 at Detroit Receiving Hospital. This intervention was coupled with reinforcement of perioperative CHG bathing and the addition of vancomycin to routine Blactam prophylaxis. Hip arthroplasty (HPRO) and knee arthroplasty (KPRO) infection rates were reviewed for 1 year before and after intervention. Results: There was a 43.25% reduction in HPRO and KPRO infections during this time period. A decrease in the average rate from 2.59 to 1.45 infections per 100 procedures (OR-0.56, p=0.24) was seen. SA infection were reduced from an average rate of 1.29 to 0.63 infections per 100 procedures (OR – 0.48, p=0.30). This resulted in a reduction of 5 infections and an approximate net cost saving of $142,409. Conclusions: Nasal decontamination with iodine offers an alternative to nasal decolonization with mupirocin in the prevention of orthopedic implant infections and was effective as part of a perioperative SSI prevention bundle.  A decrease in the average rate from 2.59 to 1.45 infections per 100 procedures (OR-0.56, p=0.24) was seen. {Rate of HPRO decreased from 2.1 to 1.86 infections per 100 procedures (OR-0.87, p=0.84) and rate of KPRO decreased from 3.07 to 1.12 infections per 100 procedures (OR0.36, p=0.14)}  SA infection were reduced from an average rate of 1.29 to 0.63 infections per 100 procedures (OR – 0.48, p=0.30).  This resulted in a reduction of 5 infections and an approximate net cost saving of $142,409. Surgical site Combined Hip and Knee prosthesis infections / # procedures by OR month x 100