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Clinical Practice Guideline for the Decolonization of Staphylococcus aureus in Surgical Patients

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2016
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DNP Project
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Decolonization Using Chlorhexidine Gluconate
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Abstract

Background: A surgical site infection (SSI) is a post-surgical complication closely linked with increased morbidity and mortality. SSIs are preventable with appropriate care and insurers no longer reimburse for their cost. Chlorhexidine Gluconate (CHG) is an antiseptic agent that is used preoperatively, often within a decolonization bundle, as a safe and cost effective means of decreasing the risk of SSIs. Objective: The purpose of this doctorate of nursing practice (DNP) project is to develop an evidence based, standardized, pre-operative CHG bathing regimen for surgical patients to be utilized in a decolonization clinical practice guideline (CPG) for elective cardiac and hip and knee arthroplasty patients at the targeted pre-op center. Design: Three DNP students developed an evidence based CPG which was evaluated for guideline quality, methodological rigor, and transparency by a group of subject matter experts (SME) (n=7) using the AGREE II tool platform. After incorporating SME feedback, the revised CPG was distributed to a group of end users (n=8) for evaluation of guideline’s quality, applicability and acceptability utilizing the Practitioner Feedback Questionnaire (PFQ). Results: All domains of the AGREE II tool were scored above the 80% benchmark with Editorial Independence scoring the highest at 94% and Applicability scoring the lowest at 82%. The PFQ Applicability scores were also low with only 35.4% favorable responses however 100% of respondents from both groups recommended this CPG for practice at their site Implications: Earlier stakeholders and end user engagement may have increased CPG applicability while decreasing staff’s reluctance to change. The finalized CPG was distributed to the Department of Infection Prevention and Hospital Epidemiology and target site staff for future implementation.

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