Susan George1, A Renee Leasure, Angela McGovern, Douglas A Horstmanshof. 1. Susan George, DNP, ACNP, CCNS, CCRN, CMC, CHFN, is a heart failure advanced practice nurse, INTEGRIS Baptist Medical Center, Oklahoma City, OK. A. Renee Leasure, PhD, RN, CNS, CCRN, is an associate professor, Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences, Oklahoma City, OK. Angela McGovern, BSN, RN, is intake coordinator for advanced heart failure therapy, INTEGRIS Baptist Medical Center, Oklahoma City, OK. Douglas A. Horstmanshof, MD, FACC, is codirector of INTEGRIS Advanced Cardiac Care Program, INTEGRIS Baptist Medical Center, Oklahoma City, OK.
Abstract
BACKGROUND: Left ventricular assist devices (LVADs) are increasingly being used in patients with advanced heart failure as bridge to transplant, bridge to decision, or destination therapy. Infections are a major complication associated with LVADs. Staphylococcus aureus is one of the common causative organisms associated with LVAD infections. Methicillin resistant staphylococcus aureus (MRSA)-colonized patients are at an increased risk for developing MRSA-associated infections. Various studies have demonstrated decolonization of skin with topical chlorhexidine and nares with 2% intranasal mupirocin ointment is effective in reducing MRSA-associated infections. OBJECTIVE: The objective of this observational study was to examine the impact of a universal decolonization protocol using topical chlorhexidine and intranasal mupirocin ointment for 5 days before LVAD implantation on postoperative infections (30, 60, and 90 days) and 30-day infection-related rehospitalization. METHODS: A preoperative universal decolonization with 4% chlorhexidine daily whole-body bath and 2% intranasal mupirocin ointment twice a day for 5 days was implemented for patients undergoing elective LVAD implantation. Using an observational study design, we included a convenience sample of 84 subjects who were established patients in an accredited advanced heart failure program. Thirty-seven patients served in the standard protocol group, and 47 in the universal decolonization protocol group participated in the observational study. RESULTS: In the standard protocol group, there were 4 MRSA infections with none in the universal decolonization group (χ = 5.34, P = .03). In total, there were 8 surgical site infections in the standard protocol group and 1 in the universal decolonization group (χ = 5.95, P = .01). CONCLUSION: A 5-day universal decolonization protocol before LVAD implantation was effective in reducing total infections as well as MRSA-specific infections.
BACKGROUND: Left ventricular assist devices (LVADs) are increasingly being used in patients with advanced heart failure as bridge to transplant, bridge to decision, or destination therapy. Infections are a major complication associated with LVADs. Staphylococcus aureus is one of the common causative organisms associated with LVAD infections. Methicillin resistant staphylococcus aureus (MRSA)-colonized patients are at an increased risk for developing MRSA-associated infections. Various studies have demonstrated decolonization of skin with topical chlorhexidine and nares with 2% intranasal mupirocin ointment is effective in reducing MRSA-associated infections. OBJECTIVE: The objective of this observational study was to examine the impact of a universal decolonization protocol using topical chlorhexidine and intranasal mupirocin ointment for 5 days before LVAD implantation on postoperative infections (30, 60, and 90 days) and 30-day infection-related rehospitalization. METHODS: A preoperative universal decolonization with 4% chlorhexidine daily whole-body bath and 2% intranasal mupirocin ointment twice a day for 5 days was implemented for patients undergoing elective LVAD implantation. Using an observational study design, we included a convenience sample of 84 subjects who were established patients in an accredited advanced heart failure program. Thirty-seven patients served in the standard protocol group, and 47 in the universal decolonization protocol group participated in the observational study. RESULTS: In the standard protocol group, there were 4 MRSA infections with none in the universal decolonization group (χ = 5.34, P = .03). In total, there were 8 surgical site infections in the standard protocol group and 1 in the universal decolonization group (χ = 5.95, P = .01). CONCLUSION: A 5-day universal decolonization protocol before LVAD implantation was effective in reducing total infections as well as MRSA-specific infections.
Authors: Hendra Setiadi; Ahmed M El-Banayosy; Susan George; David W Schmidtke; Aly El-Banayosy; Douglas A Horstmanshof; James W Long Journal: ASAIO J Date: 2021-11-10 Impact factor: 3.826
Authors: Nusaiba F Baker; Owen Brown; Alexandra M Hart; Dora Danko; Christopher M Stewart; Peter W Thompson Journal: Plast Reconstr Surg Glob Open Date: 2022-03-22