Checklist to Prevent MRSA Surgical Site Infections

Summary

The goals of this project are 1) to assess the effectiveness and cost-effectiveness of the checklist to prevent MRSA SSIs among Veterans undergoing TJA or cardiac surgery, and 2) to assess barriers and facilitators to checklist implementation.

Hypotheses:

1. The SSI checklist will be effective at reducing MRSA SSIs among total joint arthroplasty and cardiac surgery patients.
2. Implementation of the checklist will be associated with an overall reduction in SSIs caused by all pathogens.
3. The SSI Checklist will be cost-saving since it will prevent many expensive SSIs.
4. Preoperative MRSA testing will be a modifiable barrier to implementing the SSI checklist.

Conditions

• Surgical Site Infection

Interventions

DRUG

Mupirocin

Patients with known positive MRSA or MSSA and patients who have unknown status will decolonize BID x 5 days

DRUG

Chlorhexidine gluconate

Patients that are MRSA or MSSA positive or have unknown status will bathe in CHG daily x 5 days. Patients that are MRSA or MSSA negative will bathe with CHG the night before and morning of surgery.

DRUG

Cefazolin

All patients will receive Cefazolin during surgery

DRUG

Vancomycin

Patients who are positive for MRSA, or have unknown MRSA status, will receive vancomycin along with cefazolin during surgery.

DRUG

Nasal Povidone Iodine

The purpose of this research is to evaluate a SSI checklist. This checklist includes decolonizing a patient's nose and skin and optimizing antibiotics prior to surgery. At the time that we wrote it, the predominate product to decolonize patient's noses was mupirocin. However, in 2017, an FDA final monograph stated that nasal povidone-iodine may be used for pre-surgical decolonization. Nasal povidone-iodine should be able to overcome barriers to checklist implementation that we identified in Aim 3. We now plan to replace the nasal agent mupirocin with the nasal agent povidone-iodine at 3 participating medical centers (Iowa City VA, Minneapolis VA and Portland VA) to assess whether this overcomes the barriers to our SSI checklist.

Sponsors & Collaborators

• VA Office of Research and Development

  lead FED

Principal Investigators

• Eli N. Perencevich, MD MS BS · Iowa City VA Health Care System, Iowa City, IA

Study Design

Allocation

NA

Purpose

PREVENTION

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2014-04-01

Primary Completion

2021-02-28

Completion

2021-02-28

Countries

• United States

Study Locations