Prevention of Surgical Site Infections: Effectiveness of Nasal Povidone-Iodine and Nasal Mupirocin

• Measure hospital length of stay and re-admission rates in the mupirocin and povidone-iodine groups.
• Measure adverse events related to mupirocin and povidone-iodine. [ Designated as safety issue: Yes ]
• Measure rate of Staphylococcus aureus resistance to mupirocin.

We hypothesize the application of mupirocin or povidone-iodine to the nares is equally effective in short term Staphylococcus aureus(SA)suppression. Our overall study objective is to measure the rate of deep and superficial Surgical Site Infections (SSIs) after primary hip, knee, shoulder and elbow arthroplasty surgery and primary spinal fusion surgery requiring implantation of prosthetic material, when the patient receives either nasal mupirocin or nasal povidone-iodine prior to surgery.

Secondary study objectives include:

1. Measure hospital length of stay and re-admission rates in the mupirocin and povidone-iodine groups.
2. Measure adverse events related to mupirocin and povidone-iodine.
3. Measure rate of SA resistance to mupirocin.

• Drug: mupirocin calcium ointment, 2%

  Approximately one-half of the ointment from the single-use tube should be applied into 1 nostril and the other half into the other nostril twice daily (morning and evening) for 5 days.

  After application, the nostrils should be closed by pressing together and releasing the sides of the nose repetitively for approximately 1 minute. This will spread the ointment throughout the nares.

  Other Name: Bactroban Nasal
• Drug: Povidone-iodine solution 5% w/w (0.5% available iodine) Patient Preoperative Skin Preparation
  The solution is applied to for 30 seconds to each nostril twice for a total of 2 minutes. The solution is applied by rotating the applicator around the circumference of the nostril for 15 seconds and then rotating the applicator in the anterior nares for 15 seconds.
  Other Name: 3M Skin and Nasal Antiseptic

• Active Comparator: 3M Skin and Nasal Antiseptic
  Povidone-iodine solution 5% w/w (0.5% available iodine) USP Patient Preoperative Skin Preparation
  Intervention: Drug: Povidone-iodine solution 5% w/w (0.5% available iodine) Patient Preoperative Skin Preparation
• Active Comparator: Bactroban Nasal
  Mupirocin calcium ointment, 2%
  Intervention: Drug: mupirocin calcium ointment, 2%

Inclusion Criteria:

• Primary arthroplasty or spinal fusion surgery
• Age greater than 18 years

Exclusion Criteria:

• Revision arthroplasty
• Revision spinal fusion surgery
• Primary spine surgery without implantation of prosthetic material
• Allergy to mupirocin
• Allergy to povidone-iodine
• Pregnancy
• Breastfeeding