What Is the Impact of Prophylactic Nasal Decolonization in Prevention of SSI?

Abstract

<h3>Background</h3> Surgical site infections (SSI) are common preventable healthcare associated infections (HAI) that create substantial burdens on care systems, payers, and patients. Developing, implementing, sustaining SSI prevention best practices is an organizational priority. Nationally, SSIs occur in 2%-4% of all patients undergoing inpatient surgery Fiscal years 2018-2019, SSIs increased 65%; Total Hip Arthroplasty (THA), Total Knee Arthroplasty (TKA), and Spinal Fusion(SF) surgeries accounted for over half (53%) of the infections <h3>Methods</h3> In 2019, the Model Operating room (OR) project began to pilot SSI reduction strategies in the total joint surgical population. Studies have shown that Staphylococcus aureus nasal decolonization protocols reduce SSIs in elective orthopedic surgeries. Using principles of total quality management (TQM) to implement a new broad spectrum antiseptic nasal swab product, an interdisciplinary team initiated nasal decolonization in elective total hip, total knee, and spinal fusion surgical patients. <h3>Results</h3> Since September 2019, there have been zero SSIs for the 47 THAs and 79 TKA surgeries performed, and only 1 SSI for the 320 SF surgeries completed. Their collective SSI rate (0.002) has decreased 60% from 3 months prior and is 3 times lower than the SSI rate of the 797 other surgeries (0.006) performed during the 3 month nasal decolonization period. NO adverse safety events pertaining to nasal decolonization have been reported. Due to the success of the nasal decolonization initiative, other surgeons outside of the pilot populations have requested the povidone iodine nasal swab administration for their patients preoperatively. <h3>Conclusions</h3> We found preoperative nasal povidone iodine decolonization to be a safe, efficient, and cost-effective strategy in reducing SSIs in elective orthopedic surgeries. Patients and organizations may benefit from incorporating this strategy into preoperative SSI prevention protocols.