UNIVERSAL NASAL POVIDONE-IODINE STAPHYLOCOCCAL DECOLONIZATION FOR TOTAL JOINT REPLACEMENT OF THE HIP AND KNEE IN A HEALTH SAFETY-NET HOSPITAL

Introduction Hip and knee total joint arthroplasty (TJA) are among the most common surgical procedures performed in the US. Pre-operative decolonization of staphylococcal aureus carriers reduces the risk of prosthetic joint infection (PJI). Standard of care staphylococcal decolonization protocol (Mupirocin) includes nasal swab screening to identify and treat carriers with twice daily nasal mupirocin for 5 days and chlorhexidine-gluconate soap (CHG). This protocol relies on patient compliance and personnel to contact carriers. We propose a universal decolonization protocol with nasal povidone-iodine (PVP-I) administered pre-operatively on day of surgery. Methods A prospective case-control study was performed to evaluate the effect of a universal nasal PVP-I protocol implemented May 2022 in all TJA patients at a safety-net hospital versus standard of care controls. All patients were given CHG wash and MRSA nasal screens. MRSA-positive patients received prophylactic vancomycin and cefazolin. Primary outcomes: surgical site infection (SSI) and PJI; Secondary outcomes: adverse events. Chi Square test and Fisher's exact test were used to compare outcomes. Results 4667 patients were analyzed: 1242 PVP-I patients and 3425 controls. Incidence of PJI and SSI were significantly lower in the PVP-I group versus mupirocin group ((0.32% vs. 1.78%, p < 0.0001) and (0.24% vs. 0.55%, p = 0.0001), respectively). No adverse events were reported in either group. Conclusions Universal PVP-I staphylococcal decolonization was associated with reduced PJI compared to current standard of care. This protocol has benefits in a health safety-net setting as it precludes the need for follow-up screening resources, and eliminates reliance on patient compliance.