Decolonization for S. aureus Before Hip and Knee Replacements Achieved Cost Savings and Fewer SSIs

Article

While decolonization of Staphylococcus aureus reduces surgical site infection (SSI) rates following hip and knee arthroplasty, its cost-effectiveness is uncertain. Rennert-May, et al. (2019)

While decolonization of Staphylococcus aureus reduces surgical site infection (SSI) rates following hip and knee arthroplasty, its cost-effectiveness is uncertain. Rennert-May, et al. (2019) sought to examine the cost-effectiveness of a decolonization protocol for Staphylococcus aureus prior to hip and knee replacement in Alberta compared to standard care – no decolonization.

Decision analytic models and a probabilistic sensitivity analysis were used for a cost-effectiveness analysis, with the effectiveness of decolonization based on a large published pre- and post- intervention trial. The primary outcomes of the models were infections prevented and health care costs. We modelled the cost-effectiveness of decolonization in a hypothetical cohort of adult patients undergoing hip and knee replacement in Alberta, Canada. Information on the incidence of complex surgical site infections (SSIs), as well as the cost of care for patients with and without SSIs was taken from a provincial infection control database, and health administrative data.

Use of the decolonization bundle was cost saving compared to usual care ($153/person), and resulted in 16 complex Staphylococcus aureus SSIs annually as opposed to 32 (with approximately 8000 hip or knee arthroplasties performed). The probabilistic sensitivity analysis demonstrated that the majority (84%) of the time the decolonization bundle was cost saving. The model was robust to one-way sensitivity analyses conducted within plausible ranges. There were small upfront costs associated with using a decolonization protocol, however, this model demonstrated cost savings over one year. In a Markov model that considered the impact of a decolonization bundle over a lifetime as it pertained to the need for subsequent joint replacements and patient quality of life, the bundle still resulted in cost savings ($161/person).

The researchers concluded that decolonization for Staphylococcus aureus prior to hip and knee replacements resulted in cost savings and fewer SSIs, and should be considered prior to these procedures.

Reference: Rennert-May E, et al. A cost-effectiveness analysis of mupirocin and chlorhexidine gluconate for Staphylococcus aureus decolonization prior to hip and knee arthroplasty in Alberta, Canada compared to standard of care. Antimicrobial Resistance & Infection Control. 2019;8:113

Related Videos
Association for Professionals in Infection Control and Epidemiology  (Image credit: APIC)
Patient Safety: Infection Control Today's Trending Topic for March
Infection Control Today® (ICT®) talks with John Kimsey, vice president of processing optimization and customer success for Steris.
Picture at AORN’s International Surgical Conference & Expo 2024
An eye instrument holding an intraocular lens for cataract surgery. How to clean and sterilize it appropriately?   (Adobe Stock 417326809By Mohammed)
Photo of a model operating room. (Photo courtesy of Indigo-Clean and Kenall Manufacturing)
Washington, USA, US Treasury Department and Inspector General Office.    (Adobe Stock File 210945332 by Brian_Kinney)
A plasmid is a small circular DNA molecule found in bacteria and some other microscopic organisms. (Adobe Stock 522876298 by Love Employee)
Peter B. Graves, BSN, RN, CNOR, independent perioperative, consultant, speaker, and writer, Clinical Solution, LLC, Corinth, Texas; Maureen P. Spencer, M.Ed, BSN, RN, CIC, FAPIC, infection preventionist consultant, Infection Preventionist Consultants, Halifax, Massachusetts; Lena Camperlengo, DrPH, MPH, RN, Senior Director, Premier, Inc, Ocala, Florida.
Related Content