The blog Controversies in Hospital Infection Prevention is run by three charmingly indiscreet doctors who could give Dr. Joanne Liu tips on how to be a blunter critic. But they also have their cheerful side. Yesterday one of them, Dr. Eli Perencevich, posted this item: SSI Prevention Bundle in Cardiac, Hip, and Knee Surgery - A Home Run. Click through for the full post, a chart, and many links. Excerpt:
As I mentioned yesterday, it's really hard to write a post when you've already written the accompanying editorial. Today, I have a taller task - posting on a study led by two close colleagues (and favorite people), Marin Schweizer and Loreen Herwaldt. (COI alert) Fortunately, JAMA Associate Editor, Preeti Malani, has done the heavy lifting with her excellent editorial.
In today's JAMA, Schweizer and colleagues reported the results of an AHRQ-funded trial examining the benefits of an SSI prevention bundle in orthopedic and cardiac surgery. The bundle was outlined in a meta-analysis they published in BMJ two years ago and included preoperative nasal screening for MRSA/MSSA, mupirocin BID and daily CHG baths for 5 days if screen positive and vancomycin added to perioperative prophylaxis if MRSA positive.
The quasi-experimental intervention study took place in 20 US hospitals across 9 states with 39 months of pre-intervention SSI rates and 21 months of rates collected during the intervention period.
Overall, the results are impressive (i.e. not modest). First, there was a 42% reduction in SSIs after the intervention was implemented (see Figure, below), despite modest bundle adherence (39% full adherence, 44% partial adherence).
The key finding for me relates to the number of months where there were ZERO SSIs across all 20 hospitals. Looking at the Figure above, you can see that "the number of months without any complex S aureus SSIs increased from 2 of 39 months (5.1%) to 8 of 22 months (36.4%; P = .006 by Fisher exact test)." Seven times as many zero-months in all 20 hospitals. That's not a modest finding. ;)