title: Surgical site infection prevention initiative - patient attitude and compliance.
abstract: BACKGROUND
  Although the effect of Staphylococcus aureus (SA) decolonization on surgical site infection (SSI) rates has been studied, patient tolerance and acceptance of these regimens has not been assessed. Surgical patients at our hospital's Pre-Admission Testing Clinic (PAT) receive SA reduction protocols instructing the preoperative use of chlorhexidine gluconate (CHG) soap and intranasal mupirocin ointment (MO). Certain insurers do not cover MO costs resulting in out of pocket (OOP) expenses for some patients.
  
  
  OBJECTIVE
  This study assessed patient attitudes and compliance with our hospital's SA decolonization regimen.
  
  
  METHODS
  One-hundred-forty-six patients received surveys. Descriptive statistics were used for analysis.
  
  
  RESULTS
  Of respondents fitting inclusion criteria, 81% followed the MO protocol (MO users) while 89% followed the CHG protocol (CHG users). Fifty-four percent of MO users reported OOP expenses and 13% reported a hard or very hard financial burden. Ninety-three percent of CHG users reported the protocol was easy or very easy to follow.
  
  
  CONCLUSIONS
  Eighty-one percent of patients receiving the SA protocol were fully compliant despite cost or difficulty obtaining MO. Given these barriers and some difficulty with CHG application, we hypothesize compliance may be improved if MO is provided to patients without OOP expenses and if the CHG application method is simplified.
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Hospital for Joint Diseases, New York, New York, USA. nicholas.ramos@nyumc.org
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ramos
authors.forename: Faith
authors.initials: F
authors.lastname: Skeete
authors.forename: Janet P
authors.initials: JP
authors.lastname: Haas
authors.forename: Lorraine
authors.initials: L
authors.lastname: Hutzler
authors.forename: James
authors.initials: J
authors.lastname: Slover
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.forename: Joseph
authors.initials: J
authors.lastname: Bosco
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D000891:Anti-Infective Agents, Local / Q000191:economics / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006235:Hand Disinfection; D017048:Health Care Costs; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000191:economics; D009519:New York City; D009666:Nose / Q000382:microbiology; D010349:Patient Compliance; D015397:Program Evaluation; D012915:Soaps; D013131:Spine / Q000601:surgery*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D012915:Soaps; D016712:Mupirocin; C010882:chlorhexidine gluconate; D002710:Chlorhexidine