Preventing Surgical-Site Infections in Nasal Carriers ofStaphylococcus aureus

Abstract

The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission. (Current Controlled Trials number, ISRCTN56186788.)

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

“…2A) [9,11,16,20,24,26,30,43,47], the reduction of S. aureus SSIs ranged from 40% to 200% (Fig. 2B) [5,9,16,19,42,51], the reduction of MRSA SSIs ranged from 29% to 149% (Fig. 2C) [9,29,36,40,49,57], and the reduction of wound complications was reported at 4% in one study [7].…”

“…When evaluating the location of different SSIs, four studies showed that there was no statistically significant difference between the intervention group and the nonintervention group regarding deep or superficial SSIs [26,42,43,49]. However, one study [5] that decolonized only screen positive patients showed that the rate of deep SSIs decreased with use of a S. aureus decolonization protocol, and another study [29] that also decolonized only screen positive patients showed there was a significant decrease in deep SSIs with decolonization and moderate decrease in organ space or joint SSIs.…”

“…The current evidence evaluating the use of S. aureus screening and decolonization in orthopaedic patients is mostly fair, because most studies were retrospective, had smaller samples, or were published before 2007. However, there were three studies that were prospective, randomized controlled trials that showed that this screening and decolonization protocol was effective in all orthopaedic patients [5,51] and in patients undergoing total joint arthroplasty and spine surgery [26].…”

“…Of the 19 studies that evaluated the ability of S. aureus screening and decolonization to reduce SSI in orthopaedic patients, there were nine prospective studies [5,26,30,42,43,47,49,51,57] and 10 retrospective studies [7,9,11,16,19,20,24,29,36,40] (Table 1). Most studies evaluating S. aureus screening and decolonization in orthopaedic patients were conducted on patients undergoing elective total joint arthroplasty [11,16,19,20,25,30,42,43,47,49], although many studies did evaluate all elective orthopaedic patients [5,9,24,29,36,40,51,57], spine patients [7,30], and trauma patients [36].…”

“…Most studies evaluating S. aureus screening and decolonization in orthopaedic patients were conducted on patients undergoing elective total joint arthroplasty [11,16,19,20,25,30,42,43,47,49], although many studies did evaluate all elective orthopaedic patients [5,9,24,29,36,40,51,57], spine patients [7,30], and trauma patients [36]. The majority of studies detected S. aureus colonization using cultures, most SSIs were defined by CDC criteria, the majority of studies did not differentiate between superficial versus deep infections, and most of the patients who underwent decolonization were positive for S. aureus on nasal screens ( Table 2).…”