Steriwave® Nasal Photo Disinfection Prior to Endoscopic Anterior Skull base surgery: Impact on post operative SSI, meningitis and antibiotic usage
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ANTIBIOTIC PROPHYLAXIS, SURGICAL WOUND INFECTION
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Abstract
Background:
Nasal colonisation with S. aureus and MRSA increases the overall risk of surgical site infections, (SSI). Nasal decolonization recommended by NICE(1), is a topical ointment containing the antibiotic mupirocin for 5 days prior to surgery. Such regimes have a patient compliance of only 49%(2).
Steriwave® is a novel non antibiotic broad spectrum antimicrobial technology utilising photo disinfection to achieve preoperative nasal decolonisation. It is simple and quick to administer, has immediate action and does not promote antibiotic resistance(3).
Aim:
Will Steriwave have an impact on endoscopic anterior skull base surgery with regards to SSI, antibiotic usage and hospital appointments.
Methods:
Consecutive cohort study of adult patients undergoing endoscopic anterior skull base surgery with additional preoperative nasal Steriwave® photo disinfection compared to historical cohort group.
Primary outcomes: rate of SSI (including meningitis) and any antibiotic usage within 30 days of procedure.
Secondary outcome: utilisation of post operative ENT Outpatient appointments.
Fishers exact test used for comparative statistics. Powered to detect 60% reduction.
Results:
104 patients received standard nasal decolonisation and 83 received Steriwave® nasal photo disinfection.
17 /104 (16.3%) required post operative antibiotics compared to 3/83 (3.6%) in the Steriwave® group, p<0.01.
3/104 (2.9%) in historic cohort developed meningitis compared to 0/83 with Steriwave®.
1.8 post operative ENT outpatient appointments were generated pre person in the historic cohort compared to 1.05 in the Steriwave group.
Conclusion:
Compared to historical cohort data and published infection rates Steriwave® has a significant impact in reducing post operative SSI and antibiotic usage by 80% in endoscopic anterior skull base surgery. Steriwave costs £68 per patient but reduces post operative hospital bed days, antibiotic costs and post operative outpatient appointments. Developing meningitis has significant patient morbidity and additional hospital cost, £10,000.