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Implementing SSI Prevention Bundles: Potential Key to Reducing Staphylococcus Aureus Infections After Total Joint Arthroplasty

In a recent study led by Hiroyuki Suzuki, MD, MSCI, from the Iowa City Veterans Affairs Health Care System and the department of internal medicine at the University of Iowa Carver College of Medicine, it was proposed that the use of a Surgical Site Infection (SSI) prevention bundle could be associated with reduced rates of deep incisional or organ space Staphylococcus aureus surgical site infections after total joint arthroplasty (TJA).

However, Suzuki stresses the need for further research, as this association requires additional investigation outside of randomized trial settings. In an effort to explore the link between the application of SSIs prevention bundle and rates of S. aureus deep incisional SSIs, a quality improvement investigation was implemented. This investigation utilized data derived from 23,005 surgical procedures at 11 Veterans Administration hospitals. Out of these procedures, 95 S. aureus deep incisional or organ site SSIs were identified.

Early findings delivered a connection between the bundle and marked reduction in S. aureus SSIs post-total joint arthroplasty through a generalized estimating equation multivariable logistic regression model. However, an interrupted time-series multivariable logistic regression model did not show statistical significance. Moreover, no significant association was found between the bundle implementation and a decline in S. aureus SSIs after cardiac surgery.

Based on the available data, Suzuki and his team suggest a tailored bundled approach that includes S. aureus screening, nasal decolonization, and use of the most suitable perioperative antibiotic based on screening result. An efficient strategy might involve the use of cefazolin for methicillin-susceptible S. aureus and vancomycin plus cefazolin for methicillin-resistant S. aureus, combined with chlorhexidine gluconate bathing. They propose this as a way to decrease the incidence of S. aureus SSI. The results of this study demonstrate a considerable step forward in the battle against deep incisional SSIs, and offers infection prevention professionals a promising avenue for future focus.


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