887 - Implementation of a Surgical Site Infection (SSI) Prevention Bundle: Patient Compliance and Experience

Background: An evidence-based preoperative bundle including chlorhexidine gluconate (CHG) bathing, screening for S. aureus nasal carriage and decolonizing carriers with mupirocin was the standard of care for patients having total joint arthroplasty (TJA) at a VA medical center. We aimed to assess patient compliance with mupirocin and CHG, and characterize patient perceptions of barriers and facilitators to compliance.Compliance with CHG Bathing & Mupirocin By Methicillin-resistant S. aureus (MRSA) or Methicillin-susceptible S. aureus (MSSA) Colonization Status


Methods: The bundle for S. aureus colonized patients having TJA included nasal mupirocin ointment twice daily and daily CHG bathing for 5 days before surgery. The bundle for non-carriers included CHG bathing the day before and the morning of surgery. From 7/2018-10/2019, inpatients completed a 31-item survey following their TJA.

Results: 73 patients completed the survey (~29% of the TJA population). 17 patients (23%) carried S. aureus & 56 patients (77%) were non-carriers. Patients reported high compliance with home use of CHG for the full number of days directed (88% when prescribed for 2 days; 71% when prescribed for 5 days; overall 85% used as prescribed; Figure). 7 (10%) patients reported CHG side effects, including burning or itchy/dry skin. 99% of patients reported willingness to use the CHG before a future surgery. Compliance with home use of mupirocin was lower (53% used as prescribed). Reported side effects included stinging, itching or dryness (N=2, 12%), unpleasant taste (N=2, 12%) & runny or stuffy nose (N=3, 18%). 100% of patients reported willingness to use mupirocin before a future surgery. Barriers to patient compliance with the bundle included forgetfulness and difficulty bathing daily. Facilitators to patient compliance included high facility compliance with S. aureus screening (100% patients reported), patient education regarding CHG and mupirocin use (95% patients recalled), and access to prescribed medications (100% patients received). Most patients (93%) reported no financial burden for mupirocin and 95% of patients reported no financial burden for CHG.

Conclusion: Patients reported high willingness to use the prevention bundle, yet mupirocin compliance was sub-optimal. Replacing patient-applied home mupirocin with nurse-applied day-of-surgery decolonization should be assessed in order to facilitate increased compliance.