Association of bundled intervention on SSIs in patients having cardiac, hip, and knee surgery

Previous studies suggest that a bundled intervention of screening patients for nasal carriage of Staphylococcus aureus and decolonizing carriers preoperatively was associated with lower rates of surgical site infections (SSIs) in cardiac and orthopedic surgical patients. However, the effectiveness of the bundle had not been evaluated in a multicenter study.

Researchers from the University of Iowa, Iowa City, conducted a 20-hospital study to determine whether an evidence-based bundle (ie, screening for S aureus, decolonizing carriers, and prescribing perioperative antibiotics) would be associated with a lower incidence of SSIs in cardiac, hip, and knee patients compared with standard practice.

At 3 months, 83% of hospitals were adherent to the bundle. A statistically significant decline in complex SSI was found for hip or knee replacement (17 fewer infections per 10,000 procedures), but the decline was not significant for cardiac patients (6 fewer infections per 10,000 procedures).

The researchers concluded that the bundle was associated with a modest statistically significant decrease in S aureus SSIs.

An accompanying editorial notes that although the overall reduction in SSIs from the bundle seems modest, each complex SSI prevented is clinically meaningful for the patient. Development of a serious SSI after cardiac or orthopedic surgery translates into months of antibiotics, additional surgical procedures, and extended hospital stays.

—Schweizer M L, Chiang H Y, Septimus E, et al. Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery.
JAMA. 2015;313(21):2162-2171. Accompanying editorial, 2131-2132.

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