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Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution

Published online by Cambridge University Press:  10 May 2016

Michael Phillips ,
Andrew Rosenberg ,
Bo Shopsin ,
Germaine Cuff ,
Faith Skeete ,
Alycia Foti ,
Kandy Kraemer ,
Kenneth Inglima ,
Robert Press  and
Joseph Bosco
Michael Phillips*
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
Andrew Rosenberg
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
Bo Shopsin
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
Germaine Cuff
Affiliation:
New York University School of Medicine, New York, New York
Faith Skeete
Affiliation:
New York University Hospital Center, New York, New York
Alycia Foti
Affiliation:
New York University Hospital Center, New York, New York
Kandy Kraemer
Affiliation:
New York University Hospital Center, New York, New York
Kenneth Inglima
Affiliation:
New York University Hospital Center, New York, New York
Robert Press
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
Joseph Bosco
Affiliation:
New York University Hospital Center, New York, New York New York University School of Medicine, New York, New York
*
New York University Langone Medical Center, Greenberg Hall, 545 First Avenue, New York, NY 10016 (michael.phillips@nyumc.org).
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Extract

Background

Treatment of Staphylococcus aureus colonization before 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 chlorhexidine wipes in combination with either twice daily application of nasal mupirocin ointment during the 5 days before surgery or 2 applications of povidone-iodine solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery.

Results

In the modified intent-to-treat analysis, a deep SSI developed after 14 of 855 surgical procedures in the mupirocin group and 6 of 842 surgical procedures in the povidone-iodine group (P = .1); S. aureus deep SSI developed after 5 surgical procedures in the mupirocin group and 1 surgical procedure in the povidone-iodine group (P = .2). In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgical procedures in the mupirocin group and 0 of 776 surgical procedures in the povidone-iodine group (P = .03).

Conclusions

Nasal povidone-iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI.

Trial registration

ClinicalTrials.gov identifier: NCT01313182.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 826 - 832
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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