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J Hosp Infect. 2014 Oct;88(2):89-95. doi: 10.1016/j.jhin.2014.06.017. Epub 2014 Aug 1.

Nasal photodisinfection and chlorhexidine wipes decrease surgical site infections: a historical control study and propensity analysis.

Author information

1
Division of Medical Microbiology and Infection Prevention, Vancouver General Hospital, Vancouver, Canada; University of British Columbia, Vancouver, Canada. Electronic address: Elizabeth.Bryce@vch.ca.
2
Division of Medical Microbiology and Infection Prevention, Vancouver General Hospital, Vancouver, Canada; University of British Columbia, Vancouver, Canada.
3
Division of Medical Microbiology and Infection Prevention, Vancouver General Hospital, Vancouver, Canada.
4
Department of Orthopaedics, Vancouver General Hospital, Vancouver, Canada; University of British Columbia, Vancouver, Canada.
5
Peri-operative Care, Vancouver General Hospital, Vancouver, Canada.

Erratum in

  • J Hosp Infect. 2015 Sep;91(1):93.

Abstract

BACKGROUND:

Pre-operative decolonization therapy (DcTx) using chlorhexidine (CHG) body washes and/or intranasal mupirocin can reduce surgical site infections (SSIs), but compliance is often suboptimal.

AIM:

To assess the effectiveness of immediate DcTx using a novel approach of intranasal antimicrobial photodisinfection therapy (PDT) combined with CHG body wipes for the reduction of SSIs.

METHODS:

Between 1(st) September 2011 and 31(st) August 2012, 3068 elective cardiac, orthopaedic, spinal, vascular, thoracic and neurosurgical patients were treated with CHG in the 24h preceding surgery, and received intranasal PDT in the pre-operative area. SSI surveillance methodology remained unchanged from previous years and patients were followed for one year. Results were compared with those for a four-year historical control group of 12,387 patients as well as those for a concurrent control group of 206 untreated patients.

FINDINGS:

A significant reduction in the SSI rate was observed between treated patients and the historical control group [1.6% vs 2.7%, P = 0.0004, odds ratio (OR) 1.73, 95% confidence interval (CI) 1.2815-2.3453]. This significant reduction was maintained on intent-to-treat analysis (P = 0.021, OR 1.37, 95% CI 1.0476−1.7854) [corrected]. Overall compliance with DcTx was 94%. A 1:4 propensity score analysis of matched treated and untreated patients demonstrated that DcTx reduced the risk of SSIs significantly (P = 0.00026, z = 3.65).

CONCLUSION:

The combination of CHG wipes and PDT immediately before surgery reduced SSIs, achieved excellent compliance, and was easily integrated into the pre-operative routine.

KEYWORDS:

Photodisinfection therapy; Surgical site decolonization; Surgical site infections

PMID:
25171975
DOI:
10.1016/j.jhin.2014.06.017
[Indexed for MEDLINE]

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