1238. Alcohol-Based Nasal Antiseptic as Part of a Bundle to Reduce the Incidence of Contact Precautions and Surgical Site Infections

Abstract Background A 145-bed hospital embarked on a 12-month project to reduce contact precautions (CP) for colonized methicillin-resistant Staphylococcus aureus (MRSA) patients, and to reduce surgical site infections (SSI) for orthopedic patients. Prior to the project all high-risk patients were screened using nasal polymerase chain reaction (PCR) test for MRSA, and if positive, placed on CP. Orthopedic surgical patients were also screened for MRSA, and if positive, received preoperative chlorhexidine (CHG) bath and nasal mupirocin. Methods Starting in January 2017, all high-risk patients received twice-daily alcohol-based nasal antiseptic and a daily chlorhexidine (CHG) bath, in place of targeted screening and CP. In addition, an SSI prevention bundle was instituted, comprised of alcohol-based nasal antiseptic in place of mupirocin, retraining perioperative staff on skin preparation, and UV-C disinfection added to manual cleaning in the operating room. Preoperative CHG bathing was already in place and was continued. During this period, there was a total of 868 orthopedic surgery patients. Patients who remained in the hospital post-operatively received twice-daily nasal antiseptic and daily CHG bathing. Results There was a reduction in the incidence of CP from 16% to 10% per day, while maintaining a rate of zero MRSA bacteremia. Reduction of gloves, gowns and nasal PCR tests, resulted in an estimated total cost reduction of $200,000. Additionally, there was a statistically significant reduction in total hip SSI from a 2016 baseline of 1.15 infections per 100 procedures to 0.017 infections per 100 procedures (98% reduction, P = 0.014.), and the rate of zero SSI in total knee replacement patients was maintained. Conclusion Universal decolonization in place of targeted screening and CP for colonized MRSA patients, reduced costs without increasing MRSA bacteremia. Replacement of mupirocin with a nasal alcohol-based antiseptic, as one component of an SSI prevention bundle, resulted in a marked reduction in SSI after total hip procedures. Disclosures All authors: No reported disclosures.

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Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis

Hip International ◽

10.1177/1120700021991115 ◽

2021 ◽

pp. 112070002199111

Author(s):

Jacob Shapira ◽

Mitchell J Yelton ◽

Jeffery W Chen ◽

Philip J Rosinsky ◽

David R Maldonado ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Comparable Efficacy ◽

Total Hip ◽

High Risk Patients ◽

Randomised Control Trials ◽

Risk Patients

Background: The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies. Methods: The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration. Results: 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801–1.256; p = 0.489). Conclusions: NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.

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