To examine one health system's response to the essential care of its hip fracture population during the COVID-19 pandemic and report on its effect on patient outcomes.

Background Treatment of Staphylococcus aureus colonization prior to surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone iodine solution may provide an alternative to mupirocin. Methods We conducted an investigator initiated, open label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical 2% chlorhexidine gluconate (CHG) wipes with either twice daily application of mupirocin 2% ointment for the 5 days prior to surgery or two 30 second applications of povidone iodine 5% solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery caused by any pathogen or S. aureus. Results In the intent-to-treat analysis, a deep SSI developed after 14 of 855 surgeries in the mupirocin group and 6 of 842 surgeries in the povidone iodine group; S. aureus deep SSI developed after 5 surgeries in the mupirocin group and 1 surgery in the povidone iodine group. In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgeries in the mupirocin group and 0 of 776 surgeries in the povidone iodine group. Patients found to be S. aureus colonized before surgery were more likely to have a S. aureus deep SSI (OR 6.79; 95% CI 1.1–41.2; p=0.02). Conclusions Nasal povidone iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI.

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