Preoperative decolonization to reduce infections in urgent lower extremity repairs

Abstract

This retrospective review of a methicillin-resistant Staphylococcus aureus decolonization protocol using CHG bath/shower and PI-SNA nasal painting revealed a significant decrease in the infection rate of patients undergoing lower extremity fracture repairs. We recommend its use without contraindications, but recognize that additional investigations are necessary.

Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Staphylococcus aureus Decolonization

“…Overall, the clinical data published to date on intranasal PVP-I support its short-term use prior to orthopedic surgery. Its successful use in trauma patients undergoing emergency surgery within 24 h of admission is also notable, since the use of a 5-day regimen of mupirocin is not feasible in this setting (75). Recent data indicate that a single preoperative application of intranasal PVP-I may be enough for the short-term suppression of MRSA during the perioperative period (70).…”

“…Intranasal and topical PVP-I has been investigated in several studies for the preoperative decolonization of patients undergoing surgery. Four of these studies were prospective with a randomized controlled design ( 22 , 68 – 70 ), and the remaining studies were retrospective database studies with historical controls ( 71 – 75 ). The main outcome measures were either S. aureus colonization status ( 68 – 70 ) or the prevention of SSI ( 22 , 71 – 75 ).…”

“…Four of these studies were prospective with a randomized controlled design (22,(68)(69)(70), and the remaining studies were retrospective database studies with historical controls (71)(72)(73)(74)(75). The main outcome measures were either S. aureus colonization status (68)(69)(70) or the prevention of SSI (22,(71)(72)(73)(74)(75). Current World Health Organization (WHO) guidelines for decolonization recommend intranasal mupirocin with or without chlorhexidine body wash in patients with known S. aureus carriage that are undergoing cardiothoracic or orthopedic surgery 1; patients undergoing other types of surgery with known S. aureus carriage should also be considered for decolonization with the same regimen (1).…”

“…Current World Health Organization (WHO) guidelines for decolonization recommend intranasal mupirocin with or without chlorhexidine body wash in patients with known S. aureus carriage that are undergoing cardiothoracic or orthopedic surgery 1; patients undergoing other types of surgery with known S. aureus carriage should also be considered for decolonization with the same regimen (1). A summary of clinical studies investigating intranasal and topical PVP-I is presented in Table 2 (22,(68)(69)(70)(71)(72)(73)(74)(75).…”

0.5% povidone iodine irrigation in otorhinolaryngology surgical practice during COVID 19 pandemic

“…PVP-I is being extensively used all over the world as a handwashing agent (7·5%), for pre-procedural skin antisepsis [ 11 ] (10%), in ophthalmic surgery [ 12 ] (diluted to 5%) and in oral surgery (10%). Along with the office based consultations and endoscopic procedures, safety during surgical procedures is also important as the nasal, oropharyngeal, nasopharyngeal and middle ear mucosa may be carrying the SARS CoV 2.…”