{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:14:49Z","timestamp":1790028889195,"version":"4.0.1"},"reference-count":18,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n While current evidence has demonstrated a surgical site infection (SSI) prevention bundle consisting of preoperative\n Staphylococcus aureus<\/jats:italic>\n screening, nasal and skin decolonization, and use of appropriate perioperative antibiotic based on screening results can decrease rates of SSI caused by\n S aureus<\/jats:italic>\n , it is well known that interventions may need to be modified to address facility-level factors.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To assess the association between implementation of an SSI prevention bundle allowing for facility discretion regarding specific component interventions and\n S aureus<\/jats:italic>\n deep incisional or organ space SSI rates.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This quality improvement study was conducted among all patients who underwent coronary artery bypass grafting, cardiac valve replacement, or total joint arthroplasty (TJA) at 11 Veterans Administration hospitals. Implementation of the bundle was on a rolling basis with the earliest implementation occurring in April 2012 and the latest implementation occurring in July 2017. Data were collected from January 2007 to March 2018 and analyzed from October 2020 to June 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n \n Nasal screening for\n S aureus<\/jats:italic>\n ; nasal decolonization of\n S aureus<\/jats:italic>\n carriers; chlorhexidine bathing; and appropriate perioperative antibiotic prophylaxis according to\n S aureus<\/jats:italic>\n carrier status. Facility discretion regarding how to implement the bundle components was allowed.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was deep incisional or organ space SSI caused by\n S aureus<\/jats:italic>\n . Multivariable logistic regression with generalized estimating equation (GEE) and interrupted time-series (ITS) models were used to compare SSI rates between preintervention and postintervention periods.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 6696 cardiac surgical procedures and 16\u202f309 TJAs, 95\n S aureus<\/jats:italic>\n deep incisional or organ space SSIs were detected (25 after cardiac operations and 70 after TJAs). While the GEE model suggested a significant association between the intervention and decreased SSI rates after TJAs (adjusted odds ratio, 0.55; 95% CI, 0.31-0.98), there was not a significant association when an ITS model was used (adjusted incidence rate ratio, 0.88; 95% CI, 0.32-2.39). No significant associations after cardiac operations were found.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n Although this quality improvement study suggests an association between implementation of an SSI prevention bundle and decreased\n S aureus<\/jats:italic>\n deep incisional or organ space SSI rates after TJAs, it was underpowered to see a significant difference when accounting for changes over time.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.24516","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T11:40:01Z","timestamp":1689853201000},"page":"e2324516","source":"Crossref","is-referenced-by-count":10,"title":["Implementation of a Prevention Bundle to Decrease Rates of\n Staphylococcus aureus<\/i>\n Surgical Site Infection at 11 Veterans Affairs Hospitals"],"prefix":"10.1001","volume":"6","author":[{"given":"Hiroyuki","family":"Suzuki","sequence":"first","affiliation":[{"name":"Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans\u2019 Affairs Health Care System, Iowa City, Iowa"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli N.","family":"Perencevich","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans\u2019 Affairs Health Care System, Iowa City, Iowa"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Hockett Sherlock","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans\u2019 Affairs Health Care System, Iowa City, Iowa"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gosia S.","family":"Clore","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy M. J.","family":"O\u2019Shea","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans\u2019 Affairs Health Care System, Iowa City, Iowa"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme N.","family":"Forrest","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Infectious Diseases Section, VA Portland Health Care System, Portland, Oregon"},{"name":"Division of Infectious Diseases, OHSU, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasia","family":"Safdar","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Crnich","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalpana","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts"},{"name":"Center for Healthcare Organization and Implementation Research (CHOIR), Boston VA Healthcare System, Boston, Massachusetts"},{"name":"Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Strymish","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts"},{"name":"Department of Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gio Baracco","family":"Lira","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, Florida"},{"name":"Hospital Epidemiology and Occupational Health Service, Miami VA Healthcare System, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Bradley","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor"},{"name":"Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Cadena-Zuluaga","sequence":"additional","affiliation":[{"name":"South Texas Veterans Health Care System, San Antonio"},{"name":"Long School of Medicine, UT Health San Antonio, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rubin","sequence":"additional","affiliation":[{"name":"Department of Veterans\u2019 Affairs, VA Salt Lake City Healthcare System, Salt Lake City, Utah"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin","family":"Bittner","sequence":"additional","affiliation":[{"name":"Nebraska-Western Iowa Veterans Affairs Health Care System, Omaha, Nebraska"},{"name":"Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore"},{"name":"VA Maryland Health Care System, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"DeVries","sequence":"additional","affiliation":[{"name":"Minneapolis VA Medical Center, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Miell","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans\u2019 Affairs Health Care System, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Alexander","sequence":"additional","affiliation":[{"name":"Center for Access and Delivery Research & Evaluation (CADRE), Iowa City Veterans\u2019 Affairs Health Care System, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marin L.","family":"Schweizer","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison"},{"name":"William S. 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