Does a one hour educational class improve compliance of chlorhexidine gluconate baths prior to operation?

Background: Surgical site infections (SSIs) continue to be a major contributor to morbidity and mortality post-operatively. One of the treatments used to prevent such infections is chlorhexidine gluconate (CHG) baths prior to surgery. An obstacle to using CHG as a pre operative preventative measure to infection has been the low patient compliance rates. Our study aimed to analyze whether an educational class explaining the proper usage of CHG prior to the surgery date will improve patient compliance.Methods: We evaluated two different groups. One group consisted of patients who were scheduled for total joint arthroplasty (TJA) and attended an educational class in addition to receiving the standard preoperative protocol explaining the proper application of CHG. A second group consisted of subjects undergoing any other type of surgery but was not offered the additional educational class.Results: Subjects undergoing TJA had a higher compliance rate than all other surgeries (95.8% and 77.8% respectively; p < .001). Interestingly, throughout time, the effectiveness of the educational class to improve compliance also improved (from 90.9% in the first month to 100% in the final month; p < .001).Discussion: The addition of an educational class to the standard preoperative educational protocol significantly improved patient compliance to the preoperative application of CHG in TJA Patients, and increasingly so overtime. This suggests the importance of proper patient education in the prevention of costly comorbidities such as infection.Conclusions: The use of instructional classes may be useful for improving compliance to patient protocols prior to undergoing surgery. Further research is needed to fully assess the benefits of educational classes and their correlation to patient compliance.

Cost-Effectiveness of Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in an Intensive Care Unit

OBJECTIVETo create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection.DESIGNCost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection.PATIENTS AND SETTINGHypothetical cohort of 10,000 adult patients admitted to a US intensive care unit.METHODSWe compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted.RESULTSA total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy.CONCLUSIONSUniversal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.Infect Control Hosp Epidemiol 2015;36(1): 17–27