QAPI 127 - Evaluating the Effectiveness of a Modified Screen-and-treat Pre-operative Decolonization Protocol Driven by Patient-reported Staphylococcus aureus History

Background: Our large-volume orthopedic surgical hospital employs a modified screen-and-treat pre-operative decolonization protocol driven by patient-reported Staphylococcus aureus history (SAHx). Patients who report SAHx undergo pre-operative decolonization, and four-site Staphylococcus aureus (SA) surveillance cultures as time allows. We evaluated the effectiveness of patient-reported SAHx in identifying those with positive SA cultures who may be at increased risk for SA surgical site infection (SSI).

Methods: We conducted a retrospective analysis of patient-reported SAHx and surveillance cultures among 66,947 pre-surgical screening (PSS) encounters from 1/2021-11/2023 at our surgical hospital. The first PSS encounter per calendar year per patient with surgery completed within 30 days of PSS was included. Odds ratio (OR) (p-value cutoff=0.05) was calculated comparing cultures among SAHx(+) patients versus SAHx(-).

Results: 63,008 PSS encounters among 57,758 unique patients were included. 3,441 (5.5%) reported SAHx(+) with rate increasing over the study years 2021-2023 (4.0%, 5.3%, 7.1%). Select SAHx(-) patients were also cultured per physician preference, resulting in 3,539 encounters with four-site cultures. 24.2% had 1+ positive site(s), with nares being the most frequently positive (88.2%). 79.6% were colonized at only 1 site, with nares being the most frequent, followed by groin (5.4%), throat (3.7%), and axilla (1.9%). The odds of positivity among SAHx(+) was not significantly different than SAHx(-) (OR= 1.23; p=0.056; 95% CI=0.995-1.517).

Conclusions: SA surveillance with multi-site culture is time- and resource-intensive. Targeting surveillance among patients with a self-reported SAHx does not effectively capture all patients at highest risk for SA colonization who may therefore benefit from pre-operative decolonization. Point-of-care universal decolonization strategies may have more impact on SA SSI risk reduction at large-volume surgical centers.