Effective Reduction of Postoperative Infections through Routine Preoperative Decolonization with Chlorhexidine and Mupirocin Prior to Left Ventricular Assist Device Implantation

Abstract

Purpose Left ventricular assist devices (LVAD) are increasingly being used in patients with advanced heart failure. Infections are a major complication associated with LVADs. Our objective was to evaluate the impact of a decolonization protocol with chlorhexidine and intranasal mupirocin ointment on postoperative surgical site infection (SSIs), central line associated bloodstream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and infection related rehospitalization within 90 days of LVAD implantation. Methods There were 74 subjects, with 37 in a historical control group and 37 in the decolonization group. Data regarding infection in the control group was obtained from retrospective chart review, while decolonized patients were followed prospectively. Patients in the decolonization group were treated with a daily 4% chlorhexidine full-body wash as well as 2% intranasal mupirocin ointment twice daily for five days prior LVAD implantation. Results There was only 1 SSI In the decolonization group, while in the standard protocol group there were total of eight SSIs, which was statistically significant (p = 0.013). The reduction in infection was observed at each timepoint across the 90 days of follow up, suggesting a benefit from decolonization that extended beyond the immediate perioperative period. There was no difference seen in CLABSI or CAUTI. There were less rehospitalizations in the decolonization group. All of the infectious organisms identified were gram positive bacteria. Conclusion A preoperative universal decolonization with chlorhexidine and intranasal mupirocin has been effective in reducing postoperative SSIs in our LVAD patient population and has been adopted as a standard for our program. Additional studies are needed to assess the effect of universal decolonization in preventing post-operative infection in LVAD patients.