Abstract
Surgical site infections increase patient morbidity and health care costs. The Centers for Disease Control and Prevention emphasize improved basic preventive measures to reduce bacterial transmission and infections among patients undergoing surgery. To assess whether improved basic preventive measures can reduce perioperative Staphylococcus aureus transmission and surgical site infections. This randomized clinical trial was conducted from September 20, 2018, to September 20, 2019, among 19 surgeons and their 236 associated patients at a major academic medical center with a 60-day follow-up period. Participants were a random sample of adult patients undergoing orthopedic total joint, orthopedic spine, oncologic gynecological, thoracic, general, colorectal, open vascular, plastic, or open urological surgery requiring general or regional anesthesia. Surgeons and their associated patients were randomized 1:1 via a random number generator to treatment group or to usual care. Observers were masked to patient groupings during assessment of outcome measures. Sustained improvements in perioperative hand hygiene, vascular care, environmental cleaning, and patient decolonization efforts. Perioperative S aureus transmission assessed by the number of isolates transmitted and the incidence of transmission among patient care units (primary) and the incidence of surgical site infections (secondary). Of 236 patients (156 [66.1%] women; mean [SD] age, 57 [15] years), 106 (44.9%) and 130 (55.1%) were allocated to the treatment and control groups, respectively, received the intended treatment, and were analyzed for the primary outcome. Compared with the control group, the treatment group had a reduced mean (SD) number of transmitted perioperative S aureus isolates (1.25 [2.11] vs 0.47 [1.13]; P = .002). Treatment reduced the incidence of S aureus transmission (incidence risk ratio; 0.56; 95% CI, 0.37-0.86; P = .008; with robust variance clustering by surgeon: 95% CI, 0.42-0.76; P < .001). Overall, 11 patients (4.7%) experienced surgical site infections, 10 (7.7%) in the control group and 1 (0.9%) in the treatment group. Transmission was associated with an increased risk of surgical site infection (8 of 73 patients [11.0%] with transmission vs 3 of 163 [1.8%] without; risk ratio, 5.95; 95% CI, 1.62-21.86; P = .007). Treatment reduced the risk of surgical site infection (hazard ratio, 0.12; 95% CI, 0.02-0.92; P = .04; with clustering by surgeon: 95% CI, 0.03-0.51; P = .004). Improved basic preventive measures in the perioperative arena can reduce S aureus transmission and surgical site infections. ClinicalTrials.gov Identifier: NCT03638947.
Highlights
Surgical site infections (SSIs) increase patient morbidity and health care costs.[1,2,3,4,5,6,7,8] The Centers for Disease Control and Prevention (CDC) emphasize strategic improvements in basic preventive measures to prevent bacterial spread and associated infection development.[6,7]Host defenses, pathogen virulence, the microenvironment of the wound, and the size of the inoculum contribute to the pathophysiology of SSI development.[9]
Treatment reduced the incidence of S aureus transmission
Transmission was associated with an increased risk of surgical site infection (8 of 73 patients [11.0%] with transmission vs 3 of 163 [1.8%] without; risk ratio, 5.95; 95% CI, 1.62-21.86; P = .007)
Summary
Surgical site infections (SSIs) increase patient morbidity and health care costs.[1,2,3,4,5,6,7,8] The Centers for Disease Control and Prevention (CDC) emphasize strategic improvements in basic preventive measures to prevent bacterial spread and associated infection development.[6,7]. Pathogen virulence, the microenvironment of the wound, and the size of the inoculum contribute to the pathophysiology of SSI development.[9] The Surgical Care Improvement Project[10] focused on host defenses and inhibition of bacterial virulence, with complete adherence predicting a decrease in postoperative infection rates. We hypothesized that sustained improvements in perioperative hand hygiene, intravascular catheter hub disinfection, environmental cleaning, and patient decolonization efforts would generate substantial reductions in perioperative reservoir S aureus transmission that would result in SSI reduction
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have