67 - Reducing Perioperative S. aureus Transmission via use of an Evidence-Based, Multimodal Program Driven by an Innovative Software Platform
Problem: Perioperative Bacterial Transmission and Healthcare-Associated Infections (HAIs). Literature Review: Preventive strategies aimed at attenuation of perioperative S. aureus transmission are likely to reduce the incidence of HAIs and associated patient morbidity, mortality, and health care costs. This requires a multimodal approach. Hypothesis: An evidence-based bundle involving improved patient decolonization, hand hygiene, intravascular catheter design and disinfection, frequency and quality of environmental cleaning, and environmental organization will generate sustained and substantial reductions in within and between-patient S. aureus spread when optimized by an innovative surveillance platform (OR PathTrac). Conceptual Framework: OR PathTrac surveillance uses systematic phenotypic and genomic analysis to map perioperative S. aureus transmission, providing a platform for proactive bundle optimization as well as to identify, address, and to measure intervention fatigue to achieve sustainability. Methodology: We conducted a prospective, randomized study involving 236 patients (130 treatment, 106 control) at the University of Iowa (9/20/18 to 9/20/2019). Prospective, perioperative OR PathTrac S. aureus surveillance was conducted in both groups, involving 36 temporally associated patient skin, provider hand, environmental, wound, and intravascular catheter surveillance points per observational unit (8,496 surveillance points for the study). Transmission events were defined as contamination of two or more distinct, temporally associated reservoirs with S. aureus. Between-case transmission was defined as transmission events linking two patient care arenas in the same OR and/or the OR and the recovery unit (i.e. hospital floor). Data Analysis: The number of perioperative reservoirs exposed to S. aureus and transmitted S. aureus isolates for treatment and control groups were compared via the Wilcoxon rank-sum test. Poisson regression with robust variance was used to estimate the incidence risk ratios (IRR) of any or between-case transmission for the independent variable of treatment while adjusting for covariate(s) with P = 0.05 in chi-square analyses, only plastic surgery for between-case transmission.
Results: The treatment bundle with surveillance significantly reduced perioperative reservoir S. aureus exposure (P=0.0006), the number of transmitted S. aureus isolates (P=0.0020), and the incidence of any (IRR 0.56, 95% CI 0.37-0.86, P=0.008) and between-case (IRR 0.27, 05% CI 0.09-0.80, P=0.018) S. aureus transmission events.
Conclusions: An evidence-based, perioperative infection control bundle optimized by OR PathTrac surveillance significantly reduced perioperative within and between-case S. aureus exposure and transmission. Perioperative Nursing Implications: Improved basic preventive measures in the perioperative patient care arena can reduce within and between-patient spread of S. aureus, the number one cause of surgical site infections.