Major Article
Patients’ experiences and compliance with preoperative screening and decolonization

https://doi.org/10.1016/j.ajic.2022.03.013Get rights and content

Highlights

  • Reported adherence was highest at the hospital practicing universal decolonization.

  • Patients vary in their concern about surgical site infections.

  • Patients vary in the effort they will extend to prevent surgical site infections.

  • Few patients reported either barriers to adherence or side effects.

Abstract

Background

To improve adherence with pre-surgical screening for Staphylococcus aureus nasal carriage and decolonization, we need more information about patients’ experiences with these protocols.

Methods

We surveyed patients undergoing orthopedic, neurosurgical, or cardiac operations at Johns Hopkins Hospitals (JHH), the University of Iowa Hospitals and Clinics (UIHC) at MercyOne Northeast Iowa Neurosurgery (MONIN) to assess patients’ experiences with decolonization protocols.

Results

Five hundred thirty-four patients responded. Respondents at JHH were significantly more likely than those at the UIHC to report using mupirocin and were significantly more likely than those at the UIHC and MONIN to feel they received adequate information about surgical site infection (SSI) prevention and decolonization. Respondents at JHH were the least likely to not worry about SSI and they were more willing to do anything they could to prevent SSI. Few patients reported barriers to adherence and side effects of mupirocin or chlorhexidine.

Conclusion

Respondents did not report either major side effects or barriers to adherence. Patients varied in their level of concern about SSI, their willingness to invest effort in preventing SSI, and their assessments of preoperative information. To improve patients' adherence, clinicians and hospitals should assess their patients’ needs and desires and tailor their preoperative processes, education, and prophylaxis accordingly.

Section snippets

INTRODUCTION

Staphylococcus aureus causes over 30% of surgical site infections (SSIs)1 and these infections increase morbidity and healthcare costs.2, 3, 4 According to data from the National Health Safety Network5 and data from individual medical centers, S. aureus is the single most common cause of SSIs after total joint arthroplasties,6,7 cardiac operations,8,9 spinal operations,10,11 and craniotomies,12,13 causing 21%-63% of these infections.6, 7, 8, 9, 10, 11, 12, 13 Fifteen to 30% of adults in the

METHODS

A convenience sample of adult patients age 18 or older who underwent THA or TKA at Johns Hopkins Hospitals (JHH); TKA, cardiac, spine, or cranial operations at the University of Iowa Hospitals and Clinics (UIHC); and spine or cranial operations at MercyOne Northeast Iowa Neurosurgery (MONIN) completed the survey between April 2017 and September 2018. Patients were assigned unique study identification numbers.

The orthopedics team at JHH gave the survey to patients on their first post operative

RESULTS

Five hundred thirty-four surveys were returned: 100 from JHH, 214 from the UIHC, and 220 from MONIN. Respondents’ ages ranged from 18 to 90 years with an average age of 58.1 years (N = 481; due to a clerical error, age was missing for 51 patients at JHH). Age varied significantly between hospitals (Table 1; P = .0005); patients at JHH were the oldest and those at MONIN were the youngest. The proportion of female to male respondents ranged from 43.2% to 50.5%; the differences were not

DISCUSSION

S. aureus nasal carriage is a risk factor for S. aureus SSI infections and numerous studies have shown that preoperative decolonization of carriers decreases the risk.4,15, 16, 17, 18, 19, 20 However, decolonization has not been implemented in many hospitals.21,22 In addition, we previously found that adherence with screening and preoperative decolonization with five days of intranasal mupirocin and CHG bathing is less than optimal.18 During our prior multicenter quasiexperimental trial, 39% of

ACKNOWLEDGMENTS

The authors gratefully acknowledge the patients who shared their experiences with us and the staff in the surgical clinics at the University of Iowa Hospitals and Clinics, the Johns Hopkins Hospital, and MercyOne Northeast Iowa Neurosurgery for distributing and collecting the surveys. We also acknowledge Dr. Harpal (Paul) Khanuja's assistance with the survey.

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  • Cited by (0)

    Conflicts of Interest: None to report.

    Funding: The study was funded by grant 1R18HS022467-01 from the Agency for Healthcare Research and Quality.

    Current affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH.

    Current affiliation: Johns Hopkins School of Medicine, Baltimore, MD.

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