Becker's Clinical Quality & Infection Control

37 Executive Briefing decolonization protocol using mupirocin and CHG, rates of infection were similar in either group, but per patient costs were approximately $90 lower in the povidone iodine group; the bulk of the higher costs for the targeted approach are the result of the screening of all patients. 19 Conclusion ACA programs that incentivize hospitals to reduce HAIs have been in place for several years. Important new measures for MRSA and C. difficile infections were added for fiscal year 2017 payment adjustments and new measures relating to hip and knee arthroplasty slated to be implemented for fiscal year 2019 continue to demonstrate the medical and financial benefits to addressing HAIs. While horizontal approaches to infection control that cover many aspects of medical care are critical, a decolonization strategy can be particularly helpful in addressing SSIs. The growing emphasis on antibiotic steward- ship has resulted in povidone iodine emerging as an effective antiseptic alternative to antibiotics traditionally used for nasal decolonization. Based on evidence to date, implementation of universal decolonization protocols for patients undergo- ing surgery and for those in the ICU can help to lower HAI rates, resulting in significant medical and financial benefits to patients and hospitals. n Building on a century-long legacy in cleaning and disinfecting, Clorox Healthcare offers a wide range of products to help stop the spread of infection in healthcare facilities. From comprehensive surface disinfection, including advanced ultraviolet technology, to skin antisepsis, we are committed to providing efficacious solutions to the healthcare community. For more information, visit www.CloroxHealthcare.com. Sponsored by: [1] Anderson DJ et al. Clinical and financial outcomes due to methicil- lin resistant Staphylococcus aureus surgical site infection: a multi-cen- ter matched outcomes study. PLoS One. 2009 Dec 15;4(12). [2] Zimlichman E. et. al. Health Care-Associated Infections A Me- ta-analysis of Costs and Financial Impact of the US Health Care System. JAMA Internal Medicine. 2013; 173(22):2039-46. [3] Fiscal Year (FY) 2016 Results for the CMS Hospital Value-Based Purchasing Program. https://www.cms.gov/Newsroom/MediaRe- leaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-26.html Accessed March 18, 2016. [4] Fiscal Year (FY) 2016 Results for the CMS Hospital-Acquired Conditions (HAC) Reduction Program https://www.cms.gov/ Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets- items/2015-12-10-2.html Accessed March 18, 2016. [5] Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates. 80 FR 49325. August 17, 2015. Available at http://federalreg- ister.gov/a/2015-19049 Accessed March 18, 2016. [6] National Quality Measures Clearinghouse. Total hip arthroplasty (THA) and/or total knee arthroplasty (TKA): hospital-level risk-stan- dardized complication rate (RSCR) following elective primary THA and/or TKA. Agency for Healthcare Research and Quality. https:// www.qualitymeasures.ahrq.gov/content.aspx?id=49201 Accessed March 18, 2016. [7] Adapted from Septimus E et al. Approaches for Preventing Health- care-Associated Infections: Go Long or Go Wide? Infect Control Hosp Epidemiol. 2014; 35(7): Suppl 2:S10-4. [8] Kim HY et al. The effects of chlorhexidine gluconate bathing on health care-associated infection in intensive care units: A meta-analy- sis. J Crit Care. 2016 Apr;32:126-37. [9] Huang SS et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013 Jun 13;368(24):2255-65. Erratum in N Engl J Med. 2013 Aug 8;369(6):587. N Engl J Med. 2014 Feb 27;370(9):886. [10] Marschall J et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Sep;35 Suppl 2:S89-107. [11] Association for Professionals in Infection Control and Epidemiol- ogy, Inc. (APIC).Guide to Preventing Central Line-Associated Blood- stream Infections. 2015. Washington DC [12] APIC. Guide to the Elimination of Orthopedic Surgical Site Infec- tions. Washington DC, 2010. APIC; Guide for the Prevention of Medi- astinitis Surgical Site Infections Following Cardiac Surgery. Washington DC, 2008; Anderson DJ. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. SHEA/IDSA Practice Recommenda- tion. Infect Control and Hosp Epidemiol. 2014;35(6):605-627. [13] Hetem DJ, Bonten MJ. Clinical relevance of mupirocin resistance in Staphylococcus aureus. J Hosp Infect. 2013 Dec;85(4):249-56. [14] Caffrey AR et al. Low adherence to outpatient preoperative meth- icillin-resistant Staphylococcus aureus decolonization therapy. Infect Control Hosp Epidemiol. 2011 Sep;32(9):930-2. [15] Bebko SP et al. Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation. JAMA Surg. 2015 May;150(5):390-5 [16] Phillips M et al. Preventing surgical site infections: a randomized, open-label trial of nasal mupirocin ointment and nasal povidone-iodine solution. Infect Control Hosp Epidemiol. 2014 Jul;35(7):826-32. [17] Maslow J et al. Patient experience with mupirocin or povidone-io- dine nasal decolonization. Orthopedics. 2014 Jun;37(6):e576-81. [18] Lanker Klossner B et al. Nondevelopment of resistance by bacteria during hospital use of povidone-iodine. Dermatology. 1997;195 Suppl 2:10-3. [19] Torres EG et al. Is Preoperative Nasal Povidone-Iodine as Efficient and Cost-Effective as Standard Methicillin-Resistant Staphylococcus aureus Screening Protocol in Total Joint Arthroplasty? J Arthroplasty. 2016 Jan;31(1):215-8.

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