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Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization

Published online by Cambridge University Press:  24 July 2018

Susan E. Kline ,
James D. Neaton ,
Ruth Lynfield ,
Patricia Ferrieri ,
Shalini Kulasingam ,
Kayleigh Dittes ,
Anita Glennen ,
Selina Jawahir ,
Alexander Kaizer  and
Jeremiah Menk
...Show all authors
Susan E. Kline*
Affiliation:
University of Minnesota Medical School, Department of Medicine, Division of Infectious Diseases, Minneapolis, Minnesota
James D. Neaton
Affiliation:
Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota
Ruth Lynfield
Affiliation:
Minnesota Department of Health, St Paul, Minnesota
Patricia Ferrieri
Affiliation:
Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
Shalini Kulasingam
Affiliation:
Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
Kayleigh Dittes
Affiliation:
University of Minnesota Medical School, Department of Medicine, Division of Infectious Diseases, Minneapolis, Minnesota
Anita Glennen
Affiliation:
Minnesota Department of Health, St Paul, Minnesota
Selina Jawahir
Affiliation:
Minnesota Department of Health, St Paul, Minnesota
Alexander Kaizer
Affiliation:
Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota
Jeremiah Menk
Affiliation:
Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota
James R. Johnson
Affiliation:
University of Minnesota Medical School, Department of Medicine, Division of Infectious Diseases, Minneapolis, Minnesota Veterans Affairs Medical Center, Minneapolis, Minnesota
*
Author for correspondence: Susan E. Kline, Department of Medicine, Infectious Diseases Division, University of Minnesota, 420 Delaware St SE, MMC# 250, Minneapolis, MN 55455. E-mail: kline003@umn.edu
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Abstract

Objective

To determine the efficacy in eradicating Staphylococcus aureus (SA) carriage of a 5-day preoperative decolonization bundle compared to 2 disinfectant soap showers, with both regimens self-administered at home.

Design

Open label, single-center, randomized clinical trial.

Setting

Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular, and general surgery clinics at a tertiary-care referral center in the United States.

Participants

Patients at the University of Minnesota Medical Center planning to have elective surgery and not on antibiotics.

Methods

Consenting participants were screened for SA colonization using nasal, throat, axillary, and perianal swab cultures. Carriers of SA were randomized, stratified by methicillin resistance status, to a decolonization bundle group (5 days of nasal mupirocin, chlorhexidine gluconate [CHG] bathing, and CHG mouthwash) or control group (2 preoperative showers with antiseptic soap). Colonization status was reassessed preoperatively. The primary endpoint was absence of SA at all 4 screened body sites.

Results

Of 427 participants screened between August 31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers. Of these, 121 were randomized and 110 were eligible for efficacy analysis (57 decolonization bundle group, 53 control group). Overall, 90% of evaluable participants had methicillin-susceptible SA strains. Eradication of SA at all body sites was achieved for 41 of 57 participants (71.9%) in the decolonization bundle group and for 13 of 53 participants (24.5%) in the control group, a difference of 47.4% (95% confidence interval [CI], 29.1%–65.7%; P<.0001).

Conclusion

An outpatient preoperative antiseptic decolonization bundle aimed at 4 body sites was significantly more effective in eradicating SA than the usual disinfectant showers (ie, the control).

Trial Registration

ClinicalTrials.gov identifier: NCT02182115

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1049 - 1057
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: Previously presented in part in abstract and poster formats with preliminary data at IDWeek 2015 in San Diego, California, on October 9, 2015, Abstract 50804. Poster 1133 and at the SHEA 2017 conference in St Louis, Missouri, on March 30, 2017 Abstract 8723, Poster 209.

Cite this article: Kline SE, et al. (2018). Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization. Infection Control & Hospital Epidemiology 2018, 39, 1049–1057. doi: 10.1017/ice.2018.151

References

1. Noskin, GA, Rubin, RJ, Schentag, JJ, et al. The burden of Staphylococcus aureus infections on hospitals in the United States. Arch Intern Med 2005;165:1756–1761.Google Scholar
2. van Rijen, MM, Bonten, M, Wenzel, RP, Kluytmans, J. Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. J Antimicrob Chemother 2008;61:254–261.Google Scholar
3. Noskin, GA, Rubin, RJ, Schentag, JJ, et al. National trends in Staphylococcus aureus infection rates: impact on economic burden and mortality over a 6-year period (1998–2003). Clin Infect Dis 2007;45:1132–1140.Google Scholar
4. Engemann, JJ, Carmeli, Y, Cosgrove, SE. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
5. Hidron, A, Edwards, J, Patel, J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29:996–1011.Google Scholar
6. Perl, TM, Golub, JE. New approaches to reduce Staphylococcus aureus nosocomial infection rates: treating S. aureus nasal carriage. Ann Pharmacother 1998;32:S7–S16.Google Scholar
7. Wenzel, RP, Perl, TM. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infections. J Hosp Infect 1995;31:13–24.Google Scholar
8. Diekema, D, Johannsson, B, Herwaldt, L, et al. Current practice in Staphylococcus aureus screening and decolonization. Infect Control Hosp Epidemiol 2011;32:1042–1044.Google Scholar
9. Kline, S, Highness, M, Herwaldt, LA, Perl, TM. Variable screening and decolonization protocols for Staphylococcus aureus carriage prior to surgery. Infect Control Hosp Epidemiol 2014;35:880–882.Google Scholar
10. Botelho-Nevers, E, Gagnaire, J, Verhoeven, PO, et al. Decolonization of Staphylococcus aureus carriage. Med Mal Infect 2017;47:305–310.Google Scholar
11. Ban, KA, Minei, JP, Laronga, C, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. Am Coll Surg 2017;224:59–74.Google Scholar
12. Global guidelines for the prevention of surgical site infection. World Health Organization website. http://www.who.int/gpsc/ssi-guidelines/en/. Published 2016. Accessed July 21, 2017.Google Scholar
13. Parvizi, J, Shohat, N, Gehrke, T. Prevention of periprosthetic joint infection: new guidelines. Bone Joint J 2017;99(4 Suppl B):3–10.Google Scholar
14. Berríos-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784–791.Google Scholar
15. Lautenbach, E, Nachamkin, I, Baofeng, H, et al. Surveillance cultures for detection of methicillin-resistant Staphylococcus aureus: diagnostic yield of anatomic sites and comparison of provider- and patient-collected samples. Infect Control Hosp Epidemiol 2009;30:380–382.Google Scholar
16. Mody, L, Kauffman, CA, Donebedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46:1368–1373.Google Scholar
17. Kalmeijer, MD, Coertjens, H, van Nieuwland-Bollen, PM. Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis 2002;35:353–358.Google Scholar
18. Perl, TM, Cullen, JJ, Wenzel, RP. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infection. New Engl J Med 2002;346:1871–1877.Google Scholar
19. Bode, LG, Klutymans, JA, Wertheim, HF. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus . New Engl J Med 2010;362:9–17.Google Scholar
20. Segers, P, Speekenbrink, R, Ubbink, D, van Ogtrop, M, de Mol, B. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate a randomized controlled trial. JAMA 2006;296:2460–2466.Google Scholar
21. Phillips, M, Rosenberg, A, Shopsin, B, et al. Preventing surgical site infections: a randomized, open-label trial of nasal mupirocin ointment and nasal povidone-iodine solution. Infect Control Hosp Epidemiol 2014;35:826–832.Google Scholar
22. Steed, L, Costello, J, Lohia, S, Jones, T, Spannhake, E, Nguyen, S. Reduction of nasal Staphylococcus aureus carriage in health care professionals by treatment with a nonantibiotic, alcohol-based nasal antiseptic. Am J Infect Control 2014;42:841–846.Google Scholar
23. Mullen, A, Wieland, H, Wieser, E, Spannhake, E, Marinos, R. Perioperative participation of orthopedic patients and surgical staff in a nasal decolonization intervention to reduce Staphylococcus spp. surgical site infections. Am J Infect Control 2017;45:554–556.Google Scholar
24. Cullen, K, Hall, M, Golosinskiy, A. Ambulatory Surgery in the United States, 2006. National Health Statistics Reports. Number 11. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/pressroom/09newsreleases/outpatientsurgeries.htm. Published January 28, 2009; revised September 4, 2009. Accessed October 20, 2017.Google Scholar
25. Becher, K, Skov, RL, VonEiff, C. In: Jorgensen JH, Pfaller MA, Carroll KC, Funke G, Landry ML, Richter SS, Warnock DW, eds. 2015 Manual of Clinical Microbiology, 11th ed. Washington, DC: ASM Press; 2015:354–365.Google Scholar
26. Minnesota Hospital Association Slashing SSI Bundle: revised 2016. Minnesota Hospital Association website. http://www.mnhospitals.org/quality-patient-safety/quality-patient-safety-initiatives/health-care-associated-infections/surgical-site-infections. Revised 2016. Accessed July 20, 2017.Google Scholar
27. CDC/NHSN surveillance definitions for specific types of infections. National Healthcare Safety Network (NHSN) Patient Safety Component Manual. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Accessed July 15, 2017.Google Scholar
28. McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulse-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:5113–5120.Google Scholar
29. Konvalink, A, Erret, L, Fong, IW. Impact of treating Staphylococcus aureus nasal carriage on wound infections in cardiac surgery. J Hosp Infect 2006;64:162–168.Google Scholar
30. Rao, N, Canella, B, Crossett, LS. A pre-operative decolonization protocol for Staphylococcus aureus prevents orthopedic infections. Clin Orthop Relat Res 2008;466:1343–1348.Google Scholar
31. Hacek, D, Robb, W, Paule, S. Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection. Clin Orthop Relat Res 2008;466:1349–1355.Google Scholar
32. Kluytmans, JA, Mouton, JW, Marjolein, FQ. Reduction of surgical site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus . Infect Control Hosp Epidemiol 1996;17:780–784.Google Scholar
33. Schweizer, ML, Chiang, H, Septimus, E, et al. Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery. JAMA 2015;313:2162–2171.Google Scholar
34. Irish, D, Eltringham, I, Teall, A, et al. Control of an outbreak of an epidemic methicillin-resistant Staphylococcus aureus also resistant to mupirocin. J Hosp Infect 1998;39:19–26.Google Scholar
35. Hayden, MK, Lolans, K, Haffenreffer, K, et al. Chlorhexidine and mupirocin susceptibility of methicillin-resistant Staphylococcus aureus isolates in the REDUCE-MRSA trial. J Clin Microbiol 2016;54:2735–2742.Google Scholar
36. Gorwitz, RJ 1, Kruszon-Moran, D, McAllister, SK, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001–2004. J Infect Dis 2008;197:1226–1234.Google Scholar
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