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

Chen, Antonia F.; Wessel, Charles B.; Rao, Nalini

doi:10.1007/s11999-013-2875-0

Cited by 170 publications

(106 citation statements)

References 56 publications

(244 reference statements)

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“…Chen and colleagues included 19 studies related to orthopaedic surgery in their review -many with questionable methodologies. The authors concluded that all of the studies showed a reduction in surgical site infections or wound complications by instituting S aureus screening and decolonization [3]. We disagree with this analysis.…”

Section: To the Editormentioning

confidence: 84%

“…In their study, the authors studied whether Staphylococcus aureus screening and decolonization strategy reduce surgical site infections in orthopaedic surgery [3]. This question is of great concern as S aureus is a major risk factor for surgical site infections, notably in orthopaedic surgery [2,6].…”

Section: To the Editormentioning

confidence: 99%

“…We disagree with this analysis. It seems the authors considered the entire data from the Bode et al study and not data from its orthopaedic population [3].…”

Section: To the Editormentioning

confidence: 99%

See 2 more Smart Citations

Letter to the Editor

Verhoeven

Berthelot

Chapelle

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Section: To the Editormentioning

confidence: 84%

Section: To the Editormentioning

confidence: 99%

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Letter to the Editor

Verhoeven

Berthelot

Chapelle

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Culture swabs of the anterior nares can identify patients who are colonized with MRSA even though they may show no signs or symptoms of infection. 2 MRSA and other microbes have been cultured from bath basins in ICUs, 3 which may contribute to colonization of the patient's skin and lead to secondary contamination at other sites. 4 Reduction and elimination of hospital-acquired infections requires a multipronged approach.…”

mentioning

confidence: 99%

“…4,[11][12][13]16,17 Bathing with CHG also reduces MRSA skin colonization in known MRSA carrier patients during their treatment. [18][19][20][21] Several studies showed that bathing with CHG and nasal administration of mupirocin reduce the risk of infections, 2,22 and CHG bathing alone specifically reduces the risk of central catheter-associated bloodstream infections in ICU patients 4,[23][24][25][26] and long-term acute care patients. 27 Two studies 24,28 demonstrated that CHG bathing reduced the rate of blood culture contamination.…”

mentioning

confidence: 99%

Chlorhexidine Gluconate Bathing to Reduce Methicillin-Resistant Staphylococcus aureus Acquisition

Petlin

Schallom

Prentice

et al. 2014

Critical Care Nurse

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This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Discuss current research on chlorhexidine gluconate (CHG) bathing 2. Compare use of CHG-impregnated washcloths with CHG solution dissolved in bath water 3. Describe the effects of CHG bathing on methicillin-resistant Staphylococcus aureus BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. OBJECTIVES To examine the impact of a bathing protocol using chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidineimpregnated washcloths. METHODS The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS Before the protocol, 132 patients acquired MRSA in 34 333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41 376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% CI, 1.12-1.90; P = .003). The chlorhexidine soap and bath basin method cost $3.18 as compared with $5.52 for chlorhexidine-impregnated wipes (74% higher). CONCLUSIONS The chlorhexidine bathing protocol is easy to implement, cost-effective, and led to decreased unit-acquired MRSA rates in a variety of adult intensive care units. (Critical Care Nurse. 2014;34[5] Reduction and elimination of hospital-acquired infections requires a multipronged approach. Hand hygiene is the primary strategy to reduce hospital-acquired infections and prevent transmission of resistant microbes between patients.5 Rapid reporting of culture results allows the health care team to initiate timely contact isolation precautions that help reduce the spread of infection once a resistant organism is identified. A multidisciplinary critical care team partnership with infection prevention specialists can facilitate these evidence-based prevention strategies. The increase in MRSA prevalence in the community and the high level of mortality associated with MRSA (3.62 deaths per 100000 population in the United States) 1 require clinicians to continuously explore measures to prevent MRSA acquisition in critically ill patients. MRSA colonization can be a source of fear, anxiety, and uncertainty for patients.6-8 Therefore, prevention of hospital-acquired MRSA is an important nursing intervention. Chlorhexidine gluconate (CHG), a topical antiseptic solution, is effective against a wide spectrum of grampositive and...

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Bacterial Decolonization for Prevention of Radiation Dermatitis

et al. 2023

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ImportanceEvidence-based approaches for the prevention of acute radiation dermatitis (ARD) are limited, and additional strategies are necessary to optimize care.ObjectiveTo determine the efficacy of bacterial decolonization (BD) to reduce ARD severity compared with standard of care.Design, Setting, and ParticipantsThis phase 2/3 randomized clinical trial was conducted from June 2019 to August 2021 with investigator blinding at an urban academic cancer center and enrolled patients with breast cancer or head and neck cancer receiving radiation therapy (RT) with curative intent. Analysis was performed on January 7, 2022.InterventionsIntranasal mupirocin ointment twice daily and chlorhexidine body cleanser once daily for 5 days prior to RT and repeated for 5 days every 2 weeks through RT.Main Outcomes and MeasuresThe primary outcome as planned prior to data collection was the development of grade 2 or higher ARD. Based on wide clinical variability of grade 2 ARD, this was refined to grade 2 ARD with moist desquamation (grade 2-MD).ResultsOf 123 patients assessed for eligibility via convenience sampling, 3 were excluded, and 40 refused to participate, with 80 patients in our final volunteer sample. Of 77 patients with cancer (75 patients with breast cancer [97.4%] and 2 patients with head and neck cancer [2.6%]) who completed RT, 39 were randomly assigned BC, and 38 were randomly assigned standard of care; the mean (SD) age of the patients was 59.9 (11.9) years, and 75 (97.4%) were female. Most patients were Black (33.7% [n = 26]) or Hispanic (32.5% [n = 25]). Among patients with breast cancer and patients with head and neck cancer (N = 77), none of the 39 patients treated with BD and 9 of the 38 patients (23.7%) treated with standard of care developed ARD grade 2-MD or higher (P = .001). Similar results were observed among the 75 patients with breast cancer (ie, none treated with BD and 8 [21.6%] receiving standard of care developed ARD grade ≥2-MD; P = .002). The mean (SD) ARD grade was significantly lower for patients treated with BD (1.2 [0.7]) compared with patients receiving standard of care (1.6 [0.8]) (P = .02). Of the 39 patients randomly assigned to BD, 27 (69.2%) reported regimen adherence, and only 1 patient (2.5%) experienced an adverse event related to BD (ie, itch).Conclusions and RelevanceThe results of this randomized clinical trial suggest that BD is effective for ARD prophylaxis, specifically for patients with breast cancer.Trial RegistrationClinicalTrials.gov Identifier: NCT03883828

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

Abstract: Background Staphylococcus aureus is the most common organism responsible for orthopaedic surgical site infections (SSIs). Patients who are carriers for methicillin-sensitive

Cited by 170 publications

References 56 publications

Letter to the Editor

Letter to the Editor

Chlorhexidine Gluconate Bathing to Reduce Methicillin-Resistant Staphylococcus aureus Acquisition

Bacterial Decolonization for Prevention of Radiation Dermatitis

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