title: Systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery.
abstract: Surgical site infections (SSIs) are serious adverse events hindering surgical patients' recovery. In Australia and New Zealand, SSIs are a huge burden to patients and healthcare systems. A bundled approach, including pre-theatre nasal and/or skin decolonization has been used to reduce the risk of staphylococcal infection. The aim of this review is to assess the effectiveness of the bundle in preventing SSIs for cardiac and orthopaedic surgeries. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Published literature was searched in PubMed, Embase and Cochrane Library of Systematic reviews. Identified articles were selected and extracted based on a priori defined Population-Intervention-Comparator-Outcome and eligibility criteria. Data of randomized controlled trials (RCTs) and comparative observational studies were synthesized by meta-analyses. Quality appraisal tools were used to assess the evidence quality. The review included six RCTs and 19 observational studies. The bundled treatment regimens varied substantially across all studies. RCTs showed a trend of Staphylococcus aureus SSIs reduction due to the bundle (relative risk = 0.59, 95% confidence interval (CI) = 0.33, 1.06) with moderate heterogeneity. Observational studies showed statistically significant reduction in all-cause and S. aureus SSIs, with 51% (95% CI = 0.41, 0.59) and 47% (95% CI = 0.35, 0.65), respectively. No publication biases were detected. SSIs in major cardiac and orthopaedic surgeries can be effectively reduced by approximately 50% with a pre-theatre patient care bundle approach.
authors.affiliation: Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
authors.forename: Ning
authors.identifier: http://orcid.org/0000-0002-3191-8688
authors.initials: N
authors.lastname: Ma
authors.affiliation: Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
authors.forename: Alun
authors.initials: A
authors.lastname: Cameron
authors.affiliation: Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Tivey
authors.affiliation: New Zealand Health Quality & Safety Commission, Wellington, New Zealand.
authors.forename: Nikki
authors.initials: N
authors.lastname: Grae
authors.affiliation: Auckland District Health Board, Auckland, New Zealand.
authors.forename: Sally
authors.initials: S
authors.lastname: Roberts
authors.affiliation: Auckland District Health Board, Auckland, New Zealand.
authors.forename: Arthur
authors.initials: A
authors.lastname: Morris
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D064887:Observational Studies as Topic; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D064872:Patient Care Bundles / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: 
  Staphylococcus aureus
  ; meta-analysis; patient care bundle; surgical site infection; systematic review