title: Pre-operative antiseptic shower and bath policy decreases the rate of S. aureus and methicillin-resistant S. aureus surgical site infections in patients undergoing joint arthroplasty.
abstract: BACKGROUND
  Surgical site infection (SSI) following joint arthroplasty increases length of stay, hospital cost, and leads to patient and healthcare provider dissatisfaction. Due to the presence of non-biologic implants (the prosthetic joint) in these procedures, infection is often devastating and treatment of the infection is more difficult. For this reason, prevention of SSI is of crucial importance in this population. Staphylococcus aureus colonizes the nares of approximately 30-40% of the population, is the most common pathogen causing SSI, and is associated with high morbidity and mortality rate. A pre-operative shower or bath with an antiseptic is an inexpensive and effective method of removal of these transient skin pathogens prior to the procedure and may be used to decrease SSI.
  
  
  OBJECTIVE
  We hypothesize that a preoperative antiseptic shower or bath will decrease the rate of SSI.
  
  
  METHODS
  A retrospective review was performed at two affiliated hospitals within the same system, one with a hospital-wide policy enforcing pre-operative antiseptic shower or bath and the other with no policy, with cases included from January 2010 to June 2012. International Classification of Disease-Ninth Revision-Clinical Modification (ICD-9-CM) codes and chart review were used to identify patients undergoing joint arthroplasty and to identify those with SSI.
  
  
  RESULTS
  Two thousand three-hundred forty-nine arthroplasties were performed at the University of Minnesota Medical Center, a tertiary-care hospital with a pre-operative antiseptic shower or bath policy in place. An additional 1,693 procedures were performed at Fairview Ridges Hospital, a community hospital with no pre-operative policy. There was no difference in the rate of SSI between the two hospitals (1.96% vs. 1.95%; p=1.0). However, the rate of SSI caused by S. aureus was significantly decreased by pre-operative antiseptic shower/bath (17% vs. 61%; p=0.03), as was the rate of methicillin-resistant S. aureus (MRSA) infections (2% vs. 24% p=0.002).
  
  
  CONCLUSIONS
  A pre-operative antiseptic shower and bath policy was associated with a significant decrease in S. aureus and MRSA SSI, but did not decrease the total incidence of SSI. This intervention may decrease the morbidity of S. aureus SSI in this population.
authors.affiliation: Department of Surgery, University of Minnesota , Minneapolis, Minnesota.
authors.forename: Kristin
authors.initials: K
authors.lastname: Colling
authors.forename: Catherine
authors.initials: C
authors.lastname: Statz
authors.forename: James
authors.initials: J
authors.lastname: Glover
authors.forename: Kaysie
authors.initials: K
authors.lastname: Banton
authors.forename: Greg
authors.initials: G
authors.lastname: Beilman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001178:Arthroplasty / Q000009:adverse effects / Q000706:statistics & numerical data*; D001494:Baths; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local