***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: IMPORTANCE Surgical site infections ( SSIs ) , commonly caused by methicillin-resistant Staphylococcus aureus ( MRSA ) , are associated with significant morbidity and mortality , specifically when hardware is implanted in the patient . Previously , we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients . OBJECTIVE To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve data base of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston , Texas , was analyzed from October 1 , 2012 , to December 31 , 2013 . Cohort groups before and after the intervention were compared . INTERVENTIONS Starting in May 2013 , during their preoperative visit , all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery . MAIN OUTCOMES AND MEASURES Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance . Data on demographics , comorbidities such as chronic obstructive pulmonary disease and coronary artery disease , tobacco use , alcohol use , and body mass index were also collected . Univariate analysis was performed between the 2 groups of patients . Multivariate analysis was used to identify independent predictors of SSI . RESULTS A total of 709 patients were analyzed ( 344 controls and 365 patients who were decolonized ) . Both groups were well matched with no significant differences in age , body mass index , sex , or comorbidities . All of the patients ( 100 % ) completed the MRSA decontamination protocol . The SSI rate in the intervention group was significantly lower ( 1.1 % ; 4 of 365 patients developed an SSI ) than the SSI rate in the control group ( 3.8 % ; 13 of 344 patients developed an SSI ) ( P = .02 ) . Multivariate logistic regression identified MRSA decontamination as an independent predictor of not developing an SSI ( adjusted odds ratio , 0.24 [ 95 % CI , 0.08 - 0.77 ] ; P = .02 ) . CONCLUSIONS AND RELEVANCE Our study demonstrates that preoperative MRSA decontamination with chlorhexidine washcloths and oral rinse and intranasal povidone-iodine decreased the SSI rate by more than 50 % among patients undergoing elective orthopedic surgery with hardware implantation . Universal decontamination using this low-cost protocol may be considered as an additional prevention strategy for SSIs in patients undergoing orthopedic surgery with hardware implantation and warrants further study BACKGROUND Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism . Decolonization of nasal and extranasal sites on hospital admission may reduce this risk . METHODS In a r and omized , double-blind , placebo-controlled , multicenter trial , we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction ( PCR ) assay , followed by treatment with mupirocin nasal ointment and chlorhexidine soap , reduces the risk of hospital-associated S. aureus infection . RESULTS From October 2005 through June 2007 , a total of 6771 patients were screened on admission . A total of 1270 nasal swabs from 1251 patients were positive for S. aureus . We enrolled 917 of these patients in the intention-to-treat analysis , of whom 808 ( 88.1 % ) underwent a surgical procedure . All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin . The rate of S. aureus infection was 3.4 % ( 17 of 504 patients ) in the mupirocin-chlorhexidine group , as compared with 7.7 % ( 32 of 413 patients ) in the placebo group ( relative risk of infection , 0.42 ; 95 % confidence interval [ CI ] , 0.23 to 0.75 ) . The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections ( relative risk , 0.21 ; 95 % CI , 0.07 to 0.62 ) . There was no significant difference in all-cause in-hospital mortality between the two groups . The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group ( P=0.005 ) . CONCLUSIONS The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission . ( Current Controlled Trials number , IS RCT N56186788 . During two separate periods a total of 654 patients were included in a clinical study relating preoperative bacterial colonization to occurrence of postoperative wound infection in plastic surgery . During the second period one half of the patients were r and omized to receive prophylactic azithromycin . Bacteriological sample s were collected from the nasal vestibulum during both periods , and additionally from the surgical field during the second period . All patients had preoperative  chlorhexidine bathing .  The bacteriological findings were categorized as either normal flora or potentially pathogenic bacteria , and as either having no growth . Surgical wounds were divided into four contamination classes . Postoperative follow-up was 30 days , and assessment of wound infection was based on a grade d scale . We did not find any statistically significant relation between preoperative bacterial colonization and postoperative wound infection , regardless of place of sample collection , method of bacterial classification , class of contamination or use of prophylactic azithromycin INTRODUCTION Mupirocin applied to the anterior nares four times daily usually eliminates Staphylococcus aureus , including methicillin resistant , within 48 hours . Prophylactic intranasal mupirocin is safe , inexpensive and effective in reducing the overall sternal wound infection after open-heart surgery . This study was design ed to determine whether decreasing nasal bacterial colonization by applying mupirocin intra nasally decreases mediastinal , sternal , pulmonary and cutaneous infections after open-heart surgery . MATERIAL & METHODS After institutional approval and informed consent , 392 patients were included in a r and omized , prospect i ve study . Nasal cultures were taken for all patients before surgery . Patients were divided in two groups : Group I ( n = 190 ) receiving mupirocin in the anterior nares 4 times daily for 48 hours before surgery ; Group II ( n = 202 ) was the control group . Patients were followed for a month after surgery . All mediastinal , sternal , pulmonary and cutaneous infections were documented and treated with appropriate antibiotics . A Student test for quantitative data and a chi2 test for qualitative data were used for statistical analysis . p < or = 0.05 was considered significant . RESULTS The two groups had the same demographic characteristics and risk factors . Nasal carriage of Staphylococcus was 36.2 % in the two groups . Neither mediastinitis nor sternitis were noticed in any of the two groups . There was no statistical difference between the groups according to the frequency of the cutaneous infections ( Group I : 19/190 - Group II : 13/202 ) and pneumonia ( Group I : 7/190 - Group II : 13/202 ) . In patients who had nasal carriage of Staphylococcus , nasal decontamination has not shown a statistical difference of cutaneous infections of the lower limbs nor pneumonia . Although nasal decontamination reduced the incidence of sternal wound infection ( Gr I 0/190 - Gr II 4/202 ; p = 0.017 ) . Staphylococcus aureus , in the control group , induced more cutaneous infections ( 30.8 % vs 11.7 % ; p = 0.048 ) . CONCLUSION The usage of mupirocin for nasal decontamination before open-heart surgery reduces the incidence of the sternal wound infection , and does not seem to affect the frequency of cutaneous infections of the lower limbs nor pneumonia after this surgery CONTEXT Nosocomial infections are an important cause of morbidity and mortality after cardiac surgery . Decolonization of endogenous potential pathogenic microorganisms is important in the prevention of nosocomial infections . OBJECTIVE To determine the efficacy of perioperative decontamination of the nasopharynx and oropharynx with 0.12 % chlorhexidine gluconate for reduction of nosocomial infection after cardiac surgery . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve , r and omized , double-blind , placebo-controlled clinical trial conducted at the Onze Lieve Vrouwe Gasthuis , Amsterdam , the Netherl and s , between August 1 , 2003 , and September 1 , 2005 . Of 991 patients older than 18 years undergoing elective cardiothoracic surgery during the study interval , 954 were eligible for analysis . INTERVENTION Oropharyngeal rinse and nasal ointment containing either chlorhexidine gluconate or placebo . MAIN OUTCOME MEASURES Incidence of nosocomial infection , in addition to the rate of Staphylococcus aureus nasal carriage and duration of hospital stay . RESULTS The incidence of nosocomial infection in the chlorhexidine gluconate group and placebo group was 19.8 % and 26.2 % , respectively ( absolute risk reduction [ ARR ] , 6.4 % ; 95 % confidence interval [ CI ] , 1.1%-11.7 % ; P = .002 ) . In particular , lower respiratory tract infections and deep surgical site infections were less common in the chlorhexidine gluconate group than in the placebo group ( ARR , 6.5 % ; 95 % CI , 2.3%-10.7 % ; P = .002 ; and 3.2 % ; 95 % CI , 0.9%-5.5 % ; P = .002 , respectively ) . For the prevention of 1 nosocomial infection , 16 patients needed to be treated with chlorhexidine gluconate . A significant reduction of 57.5 % in S aureus nasal carriage was found in the chlorhexidine gluconate group compared with a reduction of 18.1 % in the placebo group ( P<.001 ) . Total hospital stay for patients treated with chlorhexidine gluconate was 9.5 days compared with 10.3 days in the placebo group ( ARR , 0.8 days ; 95 % CI , 0.24 - 1.88 ; P = .04 ) . CONCLUSION Decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00272675 ABSTRACT The epidemiology and risks of Staphylococcus aureus carriage in continuous peritoneal dialysis ( CPD ) patients was studied in a single tertiary-care institution . On outpatient visits sample s for culture were routinely taken prospect ively from the CPD catheter exit site and the vestibulum nasi . Seventy-five patients with at least one culture positive for S. aureus in this period were included : 43 had genotypically identical S. aureus strains in over 80 % of the cultures and were classified as persistent carriers ; 32 were intermittent carriers . Persistent carriage was associated with a threefold higher risk for CPD-related infections and sixfold higher rates of vancomycin consumption compared to those for the intermittent carriers . No methicillin or vancomycin resistance was detected To study the prevalence of Staphylococcus aureus carriage and the impact of preoperatively treating carriers in prosthetic joint infection ( PJI ) , a prospect i ve r and omized trial was organized . From January 2010 to December 2012 , 1028 of 1305 total joint arthroplasties performed were screened , and selected carriers underwent preoperative decolonization . We observed a 22.2 % ( 228/1028 ) S aureus colonization rate and only 0.8 % methicillin-resistant S aureus . Prosthetic joint infection rate was higher , albeit not significantly , in S aureus carriers than among noncarriers-3.9 % ( 9/228 ) vs 2.0 % ( 16/800 ) . Treated and untreated carriers showed no significant differences-3.4 % ( 3/89 ) vs 4.3 % ( 6/139 ) . Most of the 14 S aureus PJI occurred in noncarriers suggesting a lack of causal relation between nas 
    Output:
    
There is currently limited rigorous RCT evidence available regarding the clinical effectiveness of nasal decontamination in the prevention of SSI .