Bundled intervention for cardiac operations reduces surgical site infections

Patients undergoing cardiac operations or hip or knee arthroplasties who received a bundled intervention had a reduction in Staphylococcus aureus surgical site infections, according to a study of 20 hospitals in nine states.

Marin L. Schweizer, PhD, of the University of Iowa Carver College of Medicine in Iowa City, and colleagues published their findings online in JAMA on June 2.

They mentioned that one surgical site infection adds from $13,000 to $100,00 in healthcare costs.

Between June 1, 2012 and Oct. 9, 2012, the hospitals began implementing the bundle, which consisted of screening for Staphylococcus aureus carriage, decolonizing carriers and prescribing optimal perioperative antibiotics. The size of the hospitals ranged from 52 to 514 beds.

During preoperative clinic visits, hospital staff members swabbed patients’ nares to determine if they were MRSA and MSSA carriers. Patients who were positive for MRSA or MSSA applied mupirocin intranasally twice daily for up to five days and bathed with chlorhexidine-gluconate (CHG) daily for up to five days before their operations. Patients who were negative for MRSA and MSSA bathed with CHG the night before and the morning of their operations.

Eight hospitals implemented the bundles for joint arthroplasties, four implemented them for cardiac operations and eight implemented them for both categories. After three months, there was an 83 percent adherence rate, including 39 percent full adherence and 44 percent partial adherence.

Schweizer et al examined 42,534 operations among 38,049 patients, including 28,218 operations in the preintervention period and 14,316 operations in the intervention period. They found there were 101 complex Staphylococcus aureus surgical site infections in the preintervention period compared with 29 during the intervention period.

Patients who fully adhered to the bundle had a significant decrease in Staphylococcus aureus surgical site infections, while patients who did not adhere or only partially adhered did not have a significant decrease.

For cardiac operations, the rates of complex Staphylococcus aureus surgical site infections decreased by six operations per 10,000 operations. The rates decreased by 17 operations per 10,000 operations for hip or knee arthroplasties.