Patient outcomes after the implementation of a decolonisation protocol
in patients undergoing hip or knee replacement
Abstract
Rationale, aims and objectives Surgical-site infections (SSI) are
associated with increases in hospital length of stay and hospitalization
costs and patient’s poor quality of life. Eradication of S. aureus with
nasal mupirocin could decrease the incidence of SSI by this pathogen.
The primary purpose of our study was to evaluate the incidence of SSI
before and after the implementation of a decolonisation program in
orthopaedic patients. Methods A pre-post intervention study was
conducted. A multidisciplinary group elaborated and implemented a
standard procedure for nasal decolonisation, including a pharmacy visit.
The proportion of patients who had a SSI and those infected by S. aureus
were the primary outcome variables. The proportion of pre-screened
patients, nasal carriers, and adequate prophylaxis (3 mupirocin
applications) and decolonisation (5 applications) were recorded to
analyse program implementation. Mupirocin resistance or adverse effect
were also registered. Results 1,192 patients were included in the study
(599 pre- and 593 post-intervention group) SSI were recorded in 2.5% vs
2.0% of patients (pre vs post-intervention), showing a relative risk
(RR) of 0.81 (p=0.58). S. aureus infections were recorded in 0.7% vs
0.3% (p=0.420, RR=0.51). 59.2% vs 3.5% of patients were pre-screened
(p<0.001). 63 patients (17.9%) were nasal carriers of S.
aureus, of which 58 (92.1%) received an adequate prophylaxis and 32
(50.8%) an adequate decolonisation. No infection was reported regarding
patients who received adequate nasal prophylaxis. Conclusions The nasal
prophylaxis and decolonisation protocol were implemented in the
orthopaedic patient flow. Eradication of S. aureus with nasal mupirocin
seem to decrease the incidence of S. aureus infections.