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A Multidisciplinary Evaluation of Staphylococcus aureus Screening, Decolonization and Patient Adherence to Pre-Operative Decolonization Procedures

Ide E, Bondar S, Hockett Sherlock S, Schweizer-Looby ML, Naylor J, Kane K, Meade R, Anderson H, Uttech C, Murphree D, McKinley L, Stampfli C, Perencevich EN, Crnich C. A Multidisciplinary Evaluation of Staphylococcus aureus Screening, Decolonization and Patient Adherence to Pre-Operative Decolonization Procedures. Open forum infectious diseases. 2017 Oct 7; 4(Suppl 1):S641-S642.

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Background Colonization with Staphylococcus aureus (SA) increases the risk of surgical site infection (SSI) and de-colonization reduces this risk depending on level of patient adherence. Our VA facility's participation in a multi-site study to identify the best strategies for implementing peri-operative SA de-colonization provided an opportunity to examine the reliability of existing internal processes. The objectives of this single-site study were to asses self-reported patient adherence, and barriers to recommended de-colonization procedures, as well as to examine if current patient educational materials were sufficient. Methods A survey measuring self-reported adherence and barriers to recommended de-colonization procedures was administered by telephone. A process map of the patient education process was employed to identify key frontline staff who were asked to review existing patient education materials and procedures. A new patient education tool was then developed with their input and input from an expert in patient education. Results 34 patients responded to the telephone interview. Self-reported de-colonization adherence was 100%. 32% of patients reported high levels of social/economic deprivation and only 32% reported using medication reminders, suggesting some risk of non-adherence. Process mapping revealed that patient education was delivered through a combination of face-to-face training and printed materials. Review of the printed materials identified a number of opportunities for improvement. The newly developed patient education tool was rewritten at a 7th grade reading level and revised to include: (1) more concrete information on the benefits of SA de-colonization; (2) visual aides to enhance performance of different de-colonization tasks; and (3) a tracking log to facilitate adherence to each of the recommended de-colonization tasks. Conclusion We identified many opportunities to improve the education of patients undergoing SA de-colonization prior to high-risk surgery at our VA. Further work will need to be done to determine whether these changes positively impacted patient adherence to recommended de-colonization procedures and whether this translates into improved patient outcomes.

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