Preventing Mediastinitis with Mupirocin
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Preventing Mediastinitis with Mupirocin Keli S Holley RN BSN, Bonnie Sanderson PhD, RN Auburn University School of Nursing . What We Learned.

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Results

Preventing Mediastinitis with Mupirocin

Keli S Holley RN BSN, Bonnie Sanderson PhD, RN

Auburn University School of Nursing

What We Learned

Mediastinitis is a potentially life threatening infection that can occur in patients receiving midline sternal incisions from open heart surgery. The aim was to determine if treating patients with intranasal topical mupirocin before undergoing open heart surgery will prevent methicillin resistant staphylococcus aureus (MRSA) related surgical site infections such as mediastinitis.

Background

Results

Discussion

A clinical practice guideline suggested using mupirocin preoperatively to prevent infections giving it a Class I, Level A Recommendation (Engelman et al., 2007).

A Cochrane systematic review suggest the use of mupirocin ointment results in a statistically significant reduction in S. aureus infections including mediastinitis (van Rijen et al., 2008).

Treated with Pre-Op Bactroban Compared to the Previous Month Where Patients Were Not Treated with Bactroban

  • According to the small test of change implemented, treating patients with mupirocin shows a significant decrease in surgical site infections.

  • Other benefits from mupirocin is reducing other S. aureus infections that may grow in other wounds, urine, or sputum.

Purpose&Aims

NextSteps

  • PICO: For adult patients undergoing open-heart surgery, does treating with mupirocin (Bactroban) rather than not treating with mupirocin reduce the incidence of mediastinitis?

  • The goal to this project is to review the literature and propose a small test of change to determine if treating with mupirocin will reduce the incidence of mediastinitis.

  • Inform cardiac surgeons of the significant of using mupirocin

  • Suggest a lengthier research study that involves screening patients for MRSA preoperatively.

  • Inform infection control of the significant of using mupirocin

Limitations

The main outcome for my small test of change is to significantly lower to zero the incidences of MRSA infections post open heart surgery. However, with such a small sample size, significance may not be found. Perhaps with one year’s worth of surveillance of this evidence based project and better resources, such as the PCR essay to screen for MRSA, the project would be more significant.

Sample

  • A small test of change was implemented on patients’ ages 25 to 95 years old that received open heart surgery between February 1st, 2012 – March 1st, 2012.

  • The project includes both male and female subjects.

Acknowledgments

Thank you to East Alabama Medical Center

Key References

Methods

Engelman, R., Shahian, D., Shemin, R., Sloane, G. T., Bratzler, D., Edwards, F., . . . Bridges, C. (2007). The society of thoracic surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. The Society of Thoracic Surgeons Workforce on Evidence Based Medicine. 83(4), 1569-1576. Retrieved from: http://www.sts.org/resources-publications/clinical-practice-credentialing-guidelines/antibiotic-guidelines

van Rijen, M., Bonten, M., Wenzel, R., Kluytmans, J. (2008). Mupirocin ointment for preventing staphylococcus aureus infections in nasal carriers. Cochrane Database of Systematic Reviews 2008, Issue 4. Art.No:CD006216.

doi:10.1002/14651858.CD006216.pub2

The administration of mupirocin (Bactroban) intranasally twice a day for five days starting the day before their surgery showed an elimination of the complication of MRSA for cardiac surgery patients. Patients were routinely followed for 30 days to evaluate for infections, and data was collected and analyzed for significant improvements in surgical site infection rates.


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