(P009) IMPLEMENTATION OF STAPHYLOCOCCUS AUREUS SCREENING AND DECOLONIZATION IN CARDIAC SURGERY

Background: Staphylococcus aureus screening and decolonization is a guideline recommended treatment for the prevention of surgical site infections in cardiac surgery. Our objective was to assess the barriers and facilitators associated with the implementation of S. aureus screening and decolonization.

METHODS AND RESULTS: Targeted S. aureus screening and decolonization started at our institution in November 2022. Non-urgent inpatients and outpatients considered for cardiac surgery underwent screening, which involved performing a nasal swab to detect S. aureus. For patients who screened positive and were accepted for open-heart surgery, decolonization included Mupirocin 2% nasal ointment twice daily and Chlorhexidine 2% wipes once daily for five days. Informed by the Consolidated Framework for Implementation Research, we conducted focus group interviews approximately 6 months after initiation of the intervention to explore factors influencing implementation. Regular adjustments to implementation were made to address barriers. At the end of the one-year study period, the uptake of screening and decolonization was analyzed and a times series analysis was done to assess trends in uptake pre- and post-focus group interviews.

At one-year, 563 non-urgent inpatients and 232 outpatients were consulted to cardiac surgery. 95% of inpatients and 91% of outpatients considered for cardiac surgery were successfully screened. S. aureus was detected in 113 inpatients (8 methicillin-resistant Staphylococcus aureus [MRSA], 105 methicillin-sensitive Staphylococcus aureus [MSSA]) and 44 outpatients (3 MRSA, 41 MSSA). Major implementation barriers highlighted during focus group discussions included delays receiving screening results, difficulty meeting screening and decolonization timelines for inpatients, and staffing turnover. Implementation facilitators included dedicated research personnel, information clarity, a culture promoting change, and preprinted orders. Of the patients accepted for cardiac surgery, 50% of positive inpatients underwent decolonization in the first six months prior to focus groups compared to 67% in the following six months. For outpatients, 77% were decolonized in the first six months compared to 78% in the following six months. Efforts to increase decolonization uptake continued after the one-year study period.

Conclusion: S. aureus screening and decolonization was successfully implemented as a standard of care at our institution with the help of an Implementation Science framework. By engaging stakeholders and healthcare staff throughout the implementation process and regularly addressing barriers, we developed a sustainable S. aureus screening and decolonization program. Ongoing adjustments continue to be made to increase decolonization uptake.