A Retrospective Chart Review of a Nasal Decolonization Program to Decrease Surgical Site Infections at a Community Based Medical Center

Background: Surgical site infections (SSI’s) are a major concern for patients, providers, and healthcare organizations worldwide. SSI’s remain the costliest and most common of all hospital-acquired infections (HAI’s) (Septimus, 2019). It is estimated that SSI’s occur in 2 percent to 5 percent of all patients undergoing surgery, translating to 160,000 to 300,000 people annually at a cost of $3.5 to $10 billion (Ban et al., 2017). An SSI substantially increases morbidity and mortality as patients are twice as likely to die, are 60% more likely to be admitted to the intensive care unit (ICU), and the readmission rate is five times higher than patients who do not have a hospital-acquired SSI (Darouiche, 2019). Research Question: Did the intervention of preoperative nasal decolonization using the Profend Nasal Decolonization Kit, 10% povidone-iodine (PVP-I), reduce surgical site infections in patients undergoing an orthopedic surgery with implantation, to include total joint arthroplasty (TJA) and an orthopedic fracture repair, in a 12-month period preintervention compared to a 12-month period post-intervention? Objective: The objective of this DNP project was to evaluate the effectiveness of using a 10% PVP-I Nasal Decolonization Kits in the prevention of SSI’s in patients undergoing an orthopedic surgery for a TJA or fracture repair at the medical center. Methods: This DNP project used a retrospective data review from data points previously collected as part of standard work performed in the EMR. All patient information was blinded when the information was displayed. A standard report from the EMR was run to collect all data. Results: The preintervention group was composed of 431 patients and the postintervention group contained 365 patients. The preintervention group had eight postoperative infections for an infection rate of 1.86%. The postintervention group had an infection rate of 0.27%. This resulted in a p-value of 0.0367 using a two proportions z-score, showing a statistical improvement in SSI’s. Conclusion: The facility successfully implemented a nasal decolonization program with 10% PVP-I that decreased the number of infections, had a higher compliance rate for PVP-I nasal swab over the national average for mupirocin, and showed potential cost savings for the medical center.