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Cardiac surgery - pre-operative anti-staphylococcal bundle

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Nasal and skin decolonisation using intra-nasal mupirocin and chlorhexidine 2% wash cloths, respectively, will be used to reduce the skin burden of Gram positive bacteria prior to cardiac surgery.

  1. All children undergoing cardiac surgery will have a total body wipe with chlorhexidine 2% wash cloths the night before and morning of surgery
  2. ALL pre-operative children are to be swabbed for methicillin sensitive and methicillin resistant Staphylococcus aureus (Nasal swab only). Request on the lab requisition form "paediatric cardiac surgical patient, screen for all Staph. aureus" and use yellow lab sticky form.
  3. For children having cardiac surgery prior to swab result being available:
    1. Apply Mupirocin ointment to both nostrils twice daily (total 5 days treatment).
    1. All swab results will be followed up by the cardiac clinic nurse if child seen in clinic, or by the NP/ medical officer for in-patients. If after starting, swab result found to be negative, complete treatment course.
    2. If surgery is postponed, children are to complete the 5 days of treatment
  4. Children having cardiac surgery, where there is a recent result (<1 month) known:
      (children from overseas seen in cardiac outpatient clinic, children admitted to the cardiac- awaiting a surgical date).
    1. Treat with mupirocin ONLY if the results are positive for MRSA or MSSA.
    2. All swab results will be followed up by the cardiac clinic nurse if child seen in clinic, or by the NP/ medical officer for in-patients.
    3. Treatment can be any time in the month prior to surgery but preferably as close to the operation date as possible.
    4. For children from overseas the Overseas Patient Coordinator (ph 027 4840 982) will coordinate getting the script and supplies to the child.
    5. If MRSA positive follow ADHB Infection Prevention and Control policy
  5.  In addition: ALL children admitted to the ward who have had an overnight stay (i.e. greater than 24 hours) in another NZ or overseas hospital in the last 12 months require MRSA/ MRO screening as per the ADHB Multidrug Resistant Organism Management Policy (ADHB staff access only)

Prescribing instructions

Children < 1 year
(or children with renal impairment)
mupirocin 2% nasal ointment; apply thinly to both nostrils twice daily for 5 days
and
chlorhexidine 2%; full body wipe twice daily for 1 day pre-surgery
Children > 1 year mupirocin 2% ointment; apply to both nostrils twice daily for 5 days
and
chlorhexidine 2%; full body wipe twice daily for 1 day pre-surgery

Associated documents

Surgical antimicrobial prophylaxis (ADHB operating room guideline - see Appendix 3 of this document)

http://adhbintranet/infectioncontrol/MRO.htm (ADHB access only)

http://adhbintranet/infectioncontrol/mrsa.htm (ADHB access only)

References

  1. van Rijen M; Bonten M; Wenzel R; Kluytmans J.Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. 8;(4):CD006216. Cochrane Database Syst Rev. 2008 Oct
  2. Bode LGM;  Kluytmans JA; Wertheim HF MB; Bogaers D; et al.;. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010 362: 9-17
  3. Kluytmans JA; Mouton JW; VandenBergh MF; Manders MJ; Maat AP; Wagenvoort JH; Michel MF; Verbrugh HA. Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 1996 Dec;17(12):780-5.
  4. Kallen AJ; Wilson CT; Larson RJ Perioperative intranasal mupirocin for the prevention of surgical-site infections: systematic review of the literature and meta-analysis. Infect Control Hosp Epidemiol. 2005 Dec;26(12):916-22.
  5. Abad CL, Pulia MS, Safdar Nl Does the nose know? An Update on MRSA Decolonization Strategies. Curr Infect Dis Rep. 2013;15(6):455-464.
  6. Schweizer M, Perencevich E, McDanel J, Carson J, Formanek M, Hafner J, et al. Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopedic surgery: systematic review and meta-analysis. BMJ. 2013;346:f2743.
  7. Health Quality & Safety Commission. Antistaphylococcal bundle to reduce surgical site infections in orthopaedic and cardiac surgery. October 2016 this will be available on website soon.

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Document Control

  • Date last published: 02 November 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Cardiology, Paediatric Infectious Diseases, Clinical Microbiology
  • Author(s): John Artrip, Lesley Voss, Marion Hamer, Sally Roberts, D Buckley
  • Editor: Marion Hamer
  • Review frequency: 2 years