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

• Published in: The Journal of hospital infection 2014-10, Vol.88 (2), p.89-95
• Main Authors: Bryce, E, Wong, T, Forrester, L, Masri, B, Jeske, D, Barr, K, Errico, S, Roscoe, D
• Format: Article
• Language: English
• Subjects: Anti-Infective Agents, Local - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiseptics; Biological and medical sciences; Canada - epidemiology; Chlorhexidine - therapeutic use; Disinfection - methods; Female; General aspects; Historically Controlled Study; Human infectious diseases. Experimental studies and models; Humans; Infectious Disease; Infectious diseases; Male; Medical sciences; Middle Aged; Nose - microbiology; Patient Compliance; Pharmacology. Drug treatments; Photodisinfection therapy; Phototherapy - methods; Preoperative Care - methods; Propensity Score; Quality Improvement; Surgical site decolonization; Surgical site infections; Surgical Wound Infection - prevention & control
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2014.06.017

Summary 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 1st September 2011 and 31st August 2012, 3068 elective cardiac, orthopaedic, spinal, vascular, thoracic and neurosurgical patients were treated with CHG in the 24 h 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 1.9476–1.7854). 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.