A Clinical Practice Guideline for Staphylococcus aureus Decolonization in Select Surgical Outpatients
Other TitlesStaphylococcus Decolonization
AbstractSurgical site infections (SSI) are among the most prevalent types of hospital-acquired infections, causing substantial negative consequences for patients and health care systems, including increased morbidity and mortality rates, and higher costs to hospitals and insurers. Preoperative nasal colonization with Staphylococcus aureus (S. aureus) is an independent risk factor for the development of an SSI. Decolonization bundles that include combined use of nasal S. aureus colonization screening, targeted nasal decolonization, and preoperative Chlorhexidine gluconate (CHG) bathing are an effective means of SSI prevention. The purpose of this DNP scholarly project was to develop and evaluate an institutional clinical practice guideline (CPG) for the decolonization of S. aureus in adult, non-emergent cardiac surgery and total hip and/or knee arthroplasties. This manuscript focuses on the CHG recommendations within the larger decolonization bundle. The setting for this project was an ambulatory, Patient Readiness and Evaluation Center within a tertiary, mid-Atlantic medical center. It was anticipated that the guideline would be evaluated and graded as high quality and be considered reasonable and practical for implementation. Guided by Steven’s Stevens Star Model of Knowledge Transformation, the CPG was developed and evaluated in three phases. Prior to Phase One, a thorough evidence review and first draft of the CPG were completed. Phase One involved introductory meetings with stakeholders while Phases Two and Three were evaluation and revision phases. Two samples& Evaluation (AGREE II) Tool. The second sample consisted of eight end-users who assessed the CPG for applicability and sustainability utilizing the Practitioner Feedback Questionnaire. All six domains within the AGREE II tool scored greater than the targeted 80% agreement. The highest scoring domain was Editorial Independence with 94% agreement, while the lowest scoring domain was Applicability scoring 82% agreement. The final item, Overall Assessment of the Guideline, scored 90% agreement all SMEs stating they would recommend use of the guideline. Components that scored close to 80% were revised before Phase Three commenced. Of the four factors within the Practitioner Feedback Questionnaire, quality scored the highest with 93.75% favorable responses, while applicability of recommendations scored the lowest with 35.5% positive responses. Overall the CPG was found to be of high quality and practical for implementation with all SMEs and end-users stating they would use the CPG if it were implemented at their facility. The overarching goals of the CPG to standardize practice and minimize patient morbidity aligned with the institutional missions to deliver superior health care and discover ways to improve health outcomes. If the CPG were implemented as standard institutional practice, it is anticipated that the number of SSIs, specifically S. aureus infections, would decrease, reducing the targeted medical center’s healthcare costs and improving patient outcomes.
Staphylococcus Infections--prevention & control
Surgical Wound Infection--prevention & control
Practice Guidelines as Topic
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/6546
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