Effect of perioperative mupirocin and antiseptic body wash on infection rate and causative pathogens in patients undergoing cardiac surgery

Köhler, Philipp; Sommerstein, Rami; Schönrath, Felix; Ajdler-Schäffler, Evelyne; Anagnostopoulos, Alexia; Tschirky, Sandra; Falk, Volkmar; Kuster, Stefan P.; Sax, Hugo

doi:10.1016/j.ajic.2015.04.188

Cited by 25 publications

(40 citation statements)

References 26 publications

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“…10 Interestingly, a recent prospective study involving cardiac surgery patients found a similar reduction in superficial (but not deep or organ space) SSI rates irrespective of whether a regimen of chlorhexidine body wash and mupirocin nasal ointment was initiated before or after surgery. 8 This finding supports the potential role of postoperative contamination of surgical wounds in the causation of superficial SSIs. 10 In this regard, it might have been helpful for Durkin et al to have reported superficial and deeper space SSI rates separately to determine whether seasonal variation affected these SSIs equally.…”

Section: Seasonal Variation Of Surgical Site Infections: Why Does It supporting

confidence: 75%

“…To this end, it would have been helpful for Durkin et al to have commented on the standard screening and/or decolonization practices for Staphylococcus aureus carriage, if any, as well as preoperative skin hygiene practices by patients such as routine antiseptic body wash within 24 h prior to surgery 7,8 at participating hospitals. Furthermore, it might have been helpful to report the number of patients who underwent "same-day" surgery (ie, were admitted to the hospital on the day of an elective surgery) vs those who had already been hospitalized for ≥1 day prior to their surgery.…”

Section: Seasonal Variation Of Surgical Site Infections: Why Does It mentioning

confidence: 99%

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Seasonal Variation of Surgical Site Infections: Why Does It Occur, Why Does It Matter?

Manian

2015

Infect. Control Hosp. Epidemiol.

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The overall MDRO rectal colonization rate was 67.7%, with MDR-E. coli at 49.2%, MDR-AB at 20.1%, MDR-K. pneumoniae at 18.0%, and MDR-P. aeruginosa at 2.7%. The colonization rate for MDROs was 56.1% on day 1, and it was 73.5% by day 3, 71.4% by day 7, and 81.8% by day 14 or longer. In addition, the MDR-AB colonization rate and proportion of MDR-AB versus all MDROs isolated from the rectums of ICU patients were also positively associated with the length of stay in ICU (Table 1).We implemented a series of interventions, including enhancing the adherence to hand hygiene, disinfecting the environment using Metrex CaviWipes (Metrex) immediately after MDROs detection, and contact isolation. After interventions, the overall MDRO and MDR-AB contamination rates in the surrounding environment decreased to 10.7% and 7.1%, respectively (Table 1). Nevertheless, the overall MDRO and MDR-AB rectal colonization rates showed no significant differences (69.8% and 17.9%, respectively).These results show that contamination and colonization with MDROs, particularly MDR-AB, in the surrounding environment and rectums of ICU patients, are augmented with increasing of length of stay in ICU. The phenomenon could be explained by the spread of organisms from contaminated sites to other surfaces, the contamination of the environment by sputum, feces, blood, and body fluids from patients, and the selective pressure exerted by antibiotic use. Furthermore, Acinetobacter spp. are able to survive on inanimate surfaces for a long time, 3 thus the proportion of MDR-AB versus all MDROs on the surrounding environmental surfaces increased with length of stay in ICU. Therefore, more efforts should be put towards the cleaning and disinfection of the surrounding environment of patients, particularly those who stay in ICU for an extended time. Conventional interventions could lead to the decontamination of MDROs on the surrounding environmental surfaces; however, these procedures will not reduce rectal colonization of gram-negative MDROs. Additional measures, including decreasing unnecessary antibiotic exposure, decontamination of the digestive tract, and chlorhexidine bathing, 5 are needed for the decolonization of endosomatic MDROs. acknowledgmentsFinancial support.

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Section: Seasonal Variation Of Surgical Site Infections: Why Does It supporting

confidence: 75%

Section: Seasonal Variation Of Surgical Site Infections: Why Does It mentioning

confidence: 99%

Seasonal Variation of Surgical Site Infections: Why Does It Occur, Why Does It Matter?

Manian

2015

Infect. Control Hosp. Epidemiol.

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“…All studies contributed to the meta-analysis. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Nine of the eligible studies 19,22,24,25,[27][28][29][30]35 included cardiac patients and nine 20,21,23,26,[31][32][33]36,37 included orthopaedic patients; the remaining studies included both types of patients. Two cardiac studies were on paediatric populations 19,25 and the remaining were all adults.…”

Section: Observational Studiesmentioning

confidence: 99%

“…Mupirocin (2% ointment) was used under different regimens by 18 studies, 19,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and povidone-iodine was used in two studies as the nasal decolonization agent. 21,33 Chlorhexidine was used for skin decolonization in patients in the form of soaps for showering 19,20,[26][27][28][29]34,35,37 or wipes for skin cleansing. 21 Mouthwash using chlorhexidine was applied to patients in one study.…”

Section: Observational Studiesmentioning

confidence: 99%

“…The National Healthcare Safety Network definition of SSIs was adopted by 14 studies. [20][21][22][23][25][26][27][28]30,31,[34][35][36][37] All-cause SSIs, S. aureus SSIs, SSIs due to MRSA and MSSA were reported by the included observational studies. The meta-analysis of all 19 observational studies found a significant decrease in risk of all-cause SSIs for the bundled treatment compared with its comparator (RR = 0.49, 95% CI = (0.41, 0.59), I 2 = 46.86%) (Fig.…”

Section: (Intervention)mentioning

confidence: 99%

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Systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery

Cameron

Tivey

et al. 2017

ANZ Journal of Surgery

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Surgical site infections (SSIs) are serious adverse events hindering surgical patients' recovery. In Australia and New Zealand, SSIs are a huge burden to patients and healthcare systems. A bundled approach, including pre-theatre nasal and/or skin decolonization has been used to reduce the risk of staphylococcal infection. The aim of this review is to assess the effectiveness of the bundle in preventing SSIs for cardiac and orthopaedic surgeries. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Published literature was searched in PubMed, Embase and Cochrane Library of Systematic reviews. Identified articles were selected and extracted based on a priori defined Population-Intervention-Comparator-Outcome and eligibility criteria. Data of randomized controlled trials (RCTs) and comparative observational studies were synthesized by meta-analyses. Quality appraisal tools were used to assess the evidence quality. The review included six RCTs and 19 observational studies. The bundled treatment regimens varied substantially across all studies. RCTs showed a trend of Staphylococcus aureus SSIs reduction due to the bundle (relative risk = 0.59, 95% confidence interval (CI) = 0.33, 1.06) with moderate heterogeneity. Observational studies showed statistically significant reduction in all-cause and S. aureus SSIs, with 51% (95% CI = 0.41, 0.59) and 47% (95% CI = 0.35, 0.65), respectively. No publication biases were detected. SSIs in major cardiac and orthopaedic surgeries can be effectively reduced by approximately 50% with a pre-theatre patient care bundle approach.

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Antiseptic Stewardship for Antimicrobial Soaps

Kampf

2018

Antiseptic Stewardship

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Effect of perioperative mupirocin and antiseptic body wash on infection rate and causative pathogens in patients undergoing cardiac surgery

Cited by 25 publications

References 26 publications

Seasonal Variation of Surgical Site Infections: Why Does It Occur, Why Does It Matter?

Seasonal Variation of Surgical Site Infections: Why Does It Occur, Why Does It Matter?

Systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery

Antiseptic Stewardship for Antimicrobial Soaps

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