Patient Group Direction (PGD) decolonisation prior to surgery to reduce surgical site infection rate in spinal patients

Annesha Archyangelio and Amritpal Shakhon

Patient Group Direction (PGD) decolonisation prior to surgery to reduce surgical site infection rate in spinal patients

Annesha Archyangelio and Amritpal Shakhon

Royal National Orthopaedic Hospital, UK

: J Immunol Tech Infect Dis

Abstract

Topic: Infection prevention in specialist Orthopaedic surgery. Issue and Context: A PGD is instructions for the administration of medicine by trained professionals to a specific patient with an identified condition without them seeing a prescriber by assessing that they meet the criteria. Patient Group; Spinal patients are identified as having higher infection rates. Methods: Captured spinal patients through pre-operative assessment (POA) clinic to provide staphylococcus aureus (SA) decolonisation including Chlorhexidine 4% body/hair wash, Mupriocin 2% nasal ointment and Chlorhexidine 0.2% mouthwash to be used by prior to surgery to reduce bacterial load. Implementation started in POA in June 2014. Staff marked records for patients to whom they provided the PGD to monitor compliance and distribution. The categories of patients who did not receive the PGD/decolonisation include hips, knees, shoulders, foot and ankle and spinal patient who did not attend POA clinic. Patient in this group were screened for Methicillin-resistant Staphylococcus aureus (MRSA) in line with current practice, MRSA positive patients received standard MRSA decolonisation. Measurement Used: A post-implementation audit and review of the SA PGD from June to Dec 2014, reviewing; Patients captured on electronic Records. Reasons some patients were not given the PGD. Infection rates since introduction. Staff interviews to check process compliance. Patient surveyed to check application decolonisation. Evidence of Improvement/Findings: PGD implementation occurred smoothly. Staff/patient indicated overall compliance with the process. Patients given the PGD did not have POA or were missed. Data showed reduction in SSI rates in spinal patientÃ¢Â€Â™s post-PGD; 19 infections in period previous year, 3 infections in patients given PGD. Further Steps: Embed capture of spinal patients. Continue PGD-infection rates analysis to assess the impact of blanket decolonisation in spinal patients. Consider standard decolonisation for all orthopaedic patients pre-operatively