Effectiveness of Decolonization With Chlorhexidine and Mupirocin in Reducing Surgical Site Infections: A Systematic Review.
BACKGROUND
Surgical site infections (SSI) are a serious complication of surgery. Staphylococcus aureus (S aureus) is 1 of the most common causative organisms responsible for SSI. Patients who are carriers of methicillin-resistant S aureus and methicillin-sensitive S aureus are at increased risk of developing S aureus-associated SSIs. Decolonization of skin with chlorhexidine and nares with mupirocin may reduce the risk of SSI.


OBJECTIVE
The primary object of this systematic review is to examine the effectiveness of preoperative universal decolonization of skin with chlorhexidine and nares with intranasal mupirocin in preventing SSIs.


METHODS
The following databases were searched: Ovid Medline (from 1946 to September week 3, 2015), Embase (1947 to 2015, week 38), EBSCO CINHAL (1980-2015), Cochrane Collaboration for Systematic Reviews, EBM Reviews, and Google Scholar.


METHODS
All experimental and nonexperimental studies that evaluated the effect of chlorhexidine in combination with intranasal mupirocin for decolonization were included. Inclusion was limited to published studies written in English. A total of 19 studies were included in this review. One study was deleted from final analysis as other agents were used for skin decolonization.


METHODS
Data were extracted independently by 2 members of the study team. Discrepancies were resolved through discussion.


RESULTS
Decolonization with topical chlorhexidine and intranasal mupirocin resulted in reduction of S aureus SSI and methicillin-resistant S aureus nosocomial infection and eradication of S aureus nasal carriage. Incidence of SSIs was significantly reduced in 10 studies, which was the primary outcome. Four of the 10 studies used preoperative universal decolonization and significant reduction in SSI was observed in cardiac and orthopedic patients.


CONCLUSIONS
The results of this review indicate the combination of topical chlorhexidine and intranasal mupirocin is effective in reducing S aureus-associated SSIs.
Susan George, MSN, ACNP, CCNS, CCRN, CMC, CHFN, is an advanced practice registered nurse for INTEGRIS Advanced Cardiac Care Program at INTEGRIS Baptist Medical Center in Oklahoma City, Oklahoma. As a heart failure advanced practice nurse, she is actively involved in the care and management of heart failure and left ventricular assist device patients. A. Renee Leasure, PhD, RN, APRN-CNS, CCRN, is an associate professor at the Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center. She also has an appointment as a Research Scientist (WOC) at the Veteran's Affairs Medical Center Oklahoma City, OK. Douglas Horstmanshof, MD, FACC, is the codirector of INTEGRIS Advanced Cardiac Care at INTEGRIS Baptist Medical Center in Oklahoma City, Oklahoma. As a cardiologist who is board certified in both cardiovascular disease and advanced heart failure and transplant cardiology, he is clinically involved on a daily basis in the care of patients with advanced heart failure, left ventricular assist devices, and cardiac transplants. He is also active in clinical research as well as speaking nationally and internationally on the care of patients with advanced heart failure.
Susan
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George
A Renee
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Leasure
Douglas
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Horstmanshof
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D003428:Cross Infection; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D016712:Mupirocin / Q000627:therapeutic use*; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D016712:Mupirocin; D002710:Chlorhexidine