title: Nasal photodisinfection and chlorhexidine wipes decrease surgical site infections: a historical control study and propensity analysis.
abstract: BACKGROUND
  Pre-operative decolonization therapy (DcTx) using chlorhexidine (CHG) body washes and/or intranasal mupirocin can reduce surgical site infections (SSIs), but compliance is often suboptimal.
  
  
  OBJECTIVE
  To assess the effectiveness of immediate DcTx using a novel approach of intranasal antimicrobial photodisinfection therapy (PDT) combined with CHG body wipes for the reduction of SSIs.
  
  
  METHODS
  Between 1(st) September 2011 and 31(st) August 2012, 3068 elective cardiac, orthopaedic, spinal, vascular, thoracic and neurosurgical patients were treated with CHG in the 24h preceding surgery, and received intranasal PDT in the pre-operative area. SSI surveillance methodology remained unchanged from previous years and patients were followed for one year. Results were compared with those for a four-year historical control group of 12,387 patients as well as those for a concurrent control group of 206 untreated patients.
  
  
  RESULTS
  A significant reduction in the SSI rate was observed between treated patients and the historical control group [1.6% vs 2.7%, P = 0.0004, odds ratio (OR) 1.73, 95% confidence interval (CI) 1.2815-2.3453]. This significant reduction was maintained on intent-to-treat analysis (P = 0.021, OR 1.37, 95% CI 1.0476−1.7854) [corrected]. Overall compliance with DcTx was 94%. A 1:4 propensity score analysis of matched treated and untreated patients demonstrated that DcTx reduced the risk of SSIs significantly (P = 0.00026, z = 3.65).
  
  
  CONCLUSIONS
  The combination of CHG wipes and PDT immediately before surgery reduced SSIs, achieved excellent compliance, and was easily integrated into the pre-operative routine.
authors.affiliation: Division of Medical Microbiology and Infection Prevention, Vancouver General Hospital, Vancouver, Canada; University of British Columbia, Vancouver, Canada. Electronic address: Elizabeth.Bryce@vch.ca.
authors.forename: E
authors.initials: E
authors.lastname: Bryce
authors.affiliation: Division of Medical Microbiology and Infection Prevention, Vancouver General Hospital, Vancouver, Canada; University of British Columbia, Vancouver, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Wong
authors.affiliation: Division of Medical Microbiology and Infection Prevention, Vancouver General Hospital, Vancouver, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Forrester
authors.affiliation: Department of Orthopaedics, Vancouver General Hospital, Vancouver, Canada; University of British Columbia, Vancouver, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Masri
authors.affiliation: Peri-operative Care, Vancouver General Hospital, Vancouver, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Jeske
authors.affiliation: Peri-operative Care, Vancouver General Hospital, Vancouver, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Barr
authors.affiliation: Peri-operative Care, Vancouver General Hospital, Vancouver, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Errico
authors.affiliation: Division of Medical Microbiology and Infection Prevention, Vancouver General Hospital, Vancouver, Canada; University of British Columbia, Vancouver, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Roscoe
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D002710:Chlorhexidine / Q000627:therapeutic use*; D004203:Disinfection / Q000379:methods*; D005260:Female; D065386:Historically Controlled Study; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D010349:Patient Compliance; D010789:Phototherapy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D057216:Propensity Score; D058996:Quality Improvement; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: Photodisinfection therapy; Surgical site decolonization; Surgical site infections