It all seemed so easy
In 2010 an article was published in the New England Journal of Medicine, Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus . Patients were screened for Staphylcoccus aureus ( including MRSA, methicillin resistant Staphylococcus aureus) and those that were positive underwent a 5 day perioperative decontamination procedure with chlorhexidine baths and an antibiotic, mupirocin, in the nose. The results were impressive. Before the intervention the infection rates were 7.7 % and after the intervention it was 3.4 %. That is an impressive drop in surgical infections.
One of the orthopedic groups approached us (us being the hospital administration, pharmacy, nursing and infection control, of which I am Chair) to implement the protocol in their patients, citing a similar study on an orthopedic population. Great. It should be an easy enough intervention. I should have known better, of course, long experience has continually demonstrated that what appears to be simple never is.
First was the question as to whether the study was applicable to our patients. Resources were going to be devoted to an intervention, so going forward we had to demonstrate that the bang would be worth the buck. These are financially lean times, with cutbacks and declining reimbursement, so every expenditure of time and money needs to be justified. In the bizarro accounting of health care, not every hospital administration will include money saved in the evaluation of interventions, only the money spent. I work in a hospital system with a remarkably strong commitment to patient safety and quality, so there was little worry on that point. (more…)