1240. Evaluation of Preoperative Staphylococcus aureus (SA) Decolonization with Nasal Iodine for Hips/Knees and Fusion Surgeries

BACKGROUND: Preoperative decolonization for patients with known nasal carriage of Staphylococcus aureus is recommended in some surgical site infection (SSI) guidelines, however, meaningful implementation is often challenging with poor compliance. We evaluated utilization of nasal iodine with S. aureus polymerase chain reaction (PCR) screening on the day of surgery as an alternative approach. METHODS: For all total hip replacements (THR), total knee replacements (TKR) and fusion patients in a 250-bed community hospital, we implemented day of surgery S. aureus PCR for all patients who had not been screened in the 2 weeks prior in August 2018. Those known to have S. aureus colonization in the 2 weeks prior to surgery as well as those who had no screen in the 2 weeks prior were treated with nasal iodine and received a chlorhexidine (CHG) bath in the preoperative area. Postoperatively any patient found to have (methicillin-resistant S. aureus) MRSA from preoperative screen or who had a history of MRSA in the past year were automatically decolonized with 5 days of intranasal mupirocin and CHG baths in addition. Compliance with S. aureus screening in preoperative area, results of screens and rates of THR, TKR and fusion SSI per National Health Safety Network (NHSN) definitions were monitored throughout the study period. SSI standardized infection ratios (SIR) during the study were compared with data 1 year prior to intervention date. RESULTS: Between August 2018 and January 2019, 694 THR, TKR and fusion surgeries were performed. Preoperative nursing compliance with completing the SA screen was 79. 2% and percent compliance with administering/documenting nasal iodine was 77.8%. Of those screened 21.7% (126/578) were found to have SA. Only 15% (n = 19) of SA positive PCRs were positive for MRSA. SSIs decreased in intervention period compared with preintervention (August 2017–July 2018) as shown in Table 1. CONCLUSION: Preoperative nasal iodine has been effective and helped reduce our infection SIR to below 1. These results could be confounded by the presence of other initiatives but looks promising and large-scale studies would be helpful to make these results generalizable. [Image: see text] DISCLOSURES: All authors: No reported disclosures.