1025Impact of Nasal Decontamination with Nasal Iodine as part of a Preoperative Surgical Site Infection (SSI) Prevention Bundle in Orthopedic Implant Surgeries

Background. Nasal carriage of Staphylococcus aureus (SA) has been shown to be an independent risk factor for SA surgical site infections (SSI), with a SSI rate 2-9 times higher in carriers. Decolonization with nasal mupirocin is often recommended for carriers or high risk individuals, however this process requires preoperative screening and patient compliance with application days prior to surgery. Nasal decontamination with nasal iodine just prior to surgery offers a rapid method of decreasing the nasal burden of SA in high risk joint implant surgeries. Methods. Nasal decontamination with nasal iodine (3M Skin and Nasal Antiseptic) of all patients undergoing hip and knee prosthetic joint replacement was implemented pre-operatively since March 2013 at Detroit Receiving Hospital. This intervention was coupled with reinforcement with perioperative CHG bathing and the addition of vancomycin to routine B-lactam prophylaxis. Hip arthroplasty (HPRO) and knee arthroplasty (KPRO) infection rates were reviewed for 1 year before and after intervention. Results. There was a 28.3% reduction in HPRO and KPRO infections during this time period. A decrease in the average rate from 2.59 to 1.86 infections per 100 procedures (OR-0.56, p = 0.23) was seen. SA infection were reduced from an average rate of 1.29 to 0.63 infections per 100 procedures (OR – 0.48, p = 0.30). This resulted in a reduction of 5 infections and an approximate net cost saving of $142,409. Conclusion. Nasal decontamination with iodine offers an alternative to nasal decolonization with mupirocin in the prevention of orthopedic implant infections and was effective as part of a perioperative SSI prevention bundle. Disclosures. K. Kaye, Cubist Pharmaceuticals: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Grant recipient and Speaker honorarium