Implementing Nasal Decolonization to Prevent Surgical Site Infections (SSI) for Outpatients Undergoing Plastic Surgery

Problem: In 2023, the facility’s ambulatory surgery unit saw increased SSI, specifically in the Plastic Surgery Service line. The most common surgeries implicated were mastectomies and breast reconstructive surgeries. Context: An outpatient perioperative department at a community hospital in Northern California that performs over 12,500 surgical procedures annually. Interventions: Implement nasal decolonization protocol for all reconstructive breast surgery cases on operative day zero. Measures: Reduction of All Case SSIs Standardized Infection Ratio (SIR) in patients undergoing Plastic surgeries, primarily breast reconstructive surgery, to 0.82 or less during the three-month intervention period. Results: The All-Case SSIs for outpatient breast reconstructive surgeries in superficial incisional procedures (SIP) were reduced from a SIR of 0.82 to 0.77 during the intervention period. Likewise, deep incisional procedures (DIP) and organ space (OS) SSIs decreased from 0.85 to 0.80. Conclusions: Nasal decolonization as part of a bundled approach for SSI reduction can be an effective strategy to help reduce all cases of SSI, including surgical site infections in reconstructive breast procedures. This QI project reinforced and demonstrated the need for evidence-based practice (EBP) of nasal decolonization in additional surgeries beyond Orthopedics and Cardiovascular services. Keywords: Surgical site infection, SSI, nasal decolonization, iodophor, mupirocin, surgical wound infection, and plastic surgery