Elsevier

The Journal of Arthroplasty

Volume 32, Issue 9, September 2017, Pages 2815-2819
The Journal of Arthroplasty

Complications - Infection
Povidone-Iodine–Based Solutions for Decolonization of Nasal Staphylococcus aureus: A Randomized, Prospective, Placebo-Controlled Study

https://doi.org/10.1016/j.arth.2017.04.039Get rights and content

Abstract

Background

Nasal Staphylococcus aureus decolonization reduces the risk of surgical site infections after orthopedic procedures. Povidone-iodine (PI)-based solutions have shown promising results in bacteria decolonization. The unique physiology of the nose may pose challenges for the bioactivity profiles of PI solutions. This study compared the antibacterial efficacy of an off-the-shelf PI product with a specifically manufactured PI-based skin and nasal antiseptic (SNA).

Methods

This randomized, placebo-controlled study was conducted at a single institution between April 2014 and July 2015. Four hundred and twenty-nine patients undergoing primary or revision total joint arthroplasty, femoroacetabular osteoplasty, pelvic osteotomy, or total shoulder arthroplasty were included. 10% off-the-shelf PI, 5% PI-based SNA, or saline (placebo) were used for nasal decolonization. Baseline cultures were taken immediately preoperatively, followed by treatment of both nares twice for 2 minutes with 4 applicators. Reculturing of the right nostril occurred at 4 hours and the left at 24 hours.

Results

Ninety-five of the 429 patients (22.1%) had a positive culture result for S. aureus; 13 (3.03%) were methicillin-resistant S. aureus. Of these 95, 29 were treated with off-the-shelf PI, 34 with SNA, and 32 with saline swabs. At 4 hours post-treatment, S. aureus culture was positive in 52% off-the-shelf PI patients, 21% SNA patients, and 59% saline patients. After 24 hours posttreatment, S. aureus culture was positive in 72% off-the-shelf PI patients, 59% SNA patients, and 69% saline group. SNA was significantly more effective at decolonizing S. aureus over the 4-hour time interval (P = .003); no significant difference was observed over the 24-hour time interval between the 3 groups.

Conclusion

A single application of PI-based SNA before surgery may be effective in eliminating nasal S. aureus in over two-thirds of patients. Off-the-shelf PI swabs were not as effective at 4 hours as the specifically manufactured product for S. aureus decolonization

Section snippets

Materials and Methods

After institutional review board approval, during the 15-month enrollment period (April 2014 through July 2015), 445 primary or revision total joint arthroplasty, femoroacetabular osteoplasty, pelvic osteotomy, and total shoulder arthroplasty patients, who met the study inclusion criteria were approached for study participation; of these, 16 were excluded because of same-day discharge, which prevented us from obtaining a 24-hour post-treatment sample from these patients (Fig. 1).

The following

Results

At baseline, 95 of 429 patients (22.1%) had a positive culture result for S. aureus, of which 13 (3%) had MRSA. Of the 95 patients with positive culture results for S. aureus at baseline, 29 were decolonized with off-the-shelf PI, 34 were treated with 5% PI-based SNA, and 32 were decolonized using saline swabs. At 4 hours post-treatment, of those with a positive baseline result, S. aureus culture result was positive in 52% off-the-shelf PI group (15 of 29), 21% SNA group (7/34), and 59% saline

Discussion

The increasing burden of SSI has led numerous societies and governmental organizations to seek effective strategies for prevention. The Centers for Disease Control and Prevention, for example, will soon be issuing updated guidelines for SSI prevention [25]. The financial burden that SSI poses on society is immense. The prevention of a single case of SSI can save $42,300 for hospitals, and overall prevention can reduce the length of hospitalization by 50% [23].

One strategy for reduction of SSI

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    The study was funded by the institution and there was no industry funding for this study.

    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.04.039.

    ClinicalTrials.gov Identifier: NCT02652325 (Nasal swab study comparison of effectiveness of povidone-iodine versus saline versus 3M Skin and Nasal Antiseptic 5% povidone-iodine USP swabs for decolonizing intranasal MSSA/MRSA).

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