DISCUSSION

In this study, we investigated the HCP knowledge of, perceptions of, and barriers to successfully implementing a USD protocol. It is imperative that HCP understand the USD kit protocol and the potential benefits of universally decolonizing patients who are undergoing elective surgical procedures. Approximately 93% of HCP understood the USD protocol, yet 15% were unsure whether the USD kit was necessary or beneficial for patients. Approximately 33% of respondents disagreed or were unaware of the cost efficiency of screening and/or decolonizing patients prior to joint replacement surgeries. Although a cost assessment was not performed for our patient population, a recent report suggests that staphylococcal decolonization is cost-effective in pre-surgical patient preparation for orthopedic joint-replacement surgeries.Reference Hacek, Robb, Paule, Kudrna, Stamos and Peterson ⁵ Approximately 50% of the survey respondents were either unaware or disagreed that USD is more effective than selective decolonization in preventing post-surgical infections in orthopaedics. Although many HCP understood the process of the USD protocol, many did not understand the importance and potential benefits of universal staphylococcal decolonization in orthopaedics, limiting their ability to educate patients.

Other barriers to successfully implementing the USD kit protocol include time and convenience, cost, patient and staff compliance, and lack of education. Only 62% of respondents believed that patients were being properly screened and/or decolonized before surgery. Although we now have data regarding adherence to USD kit protocols at time of preoperative visit (607 of 645, 94%), we do not have a method for determining patient compliance with USD kit use.

Our study has some limitations. The single-center design may not be accurately generalized to other care environments. In addition, we only had 55 respondents of a possible 79 who were given the questionnaire. Although the questionnaire was anonymous, responses may have been subject to recall bias or inaccuracy.

The successful implementation of a USD kit must be comprehensive. All providers involved in perioperative care must understand the rationale and expected impact of a USD program. Based on our study, we will provide education regarding the benefits of the USD kit, and we will clarify the complementary but distinct purpose of MRSA screening for all involved HCP. Our protocol for dispensation of USD materials is effective; however, we lack specific materials for non-English speakers. Assessment of patient comprehension and compliance monitoring may also improve performance. Finally, formalized feedback of USD dispensation to surgical departments will be added to existing SSI feedback along with ongoing monitoring of USD program effectiveness .