Application of an integrated behavioral model to predict compliance with decontamination therapy in MRSA-colonized patients undergoing elective surgery with hardware implantation

In the US, surgical site infections (SSIs), which are the second most common hospital-acquired infection among surgical patients, are potentially preventable. Specifically, MRSA infections carry a significantly high morbidity and mortality (2–11 fold higher) with 75% of the deaths attributable directly to the SSI. Multiple measures have been adopted to decrease SSI rates with little substantial effect on SSI rates. Identifying MRSA carriers preoperatively, and asking the patients to perform the MRSA decontamination therapy with intranasal mupirocin and chlorhexidine body wash at home daily for 5 days prior to surgery (MRSA decontamination) could potentially decrease SSI rates. The compliance rate for decontamination has been variable and low. The IBM provides a theoretical basis from which to better understand intention to perform MRSA decontamination behavior and identify specific beliefs to target in order to improve compliance. The IBM consists of internal variables (attitude, perceived norm, perceived control, self-efficacy) that impact intention to perform the behavior and external variables (environmental constraints, knowledge skill, salience, habit) along with intention that directly impact a health behavior. The goals of this study were to adopt the IBM as the conceptual framework to understand MRSA decontamination and to determine if there is an association the internal constructs with the intention to perform the preoperative decontamination therapy. In addition, the external variables which impact behavior were also examined. Finally, the impact of an educational/instructional video was assessed. Our results demonstrate that perceived control and self-efficacy were independently associated with the intention to perform the behavior. In addition, the external variables of knowledge skills and environmental constraints were also independently associated with intention. Finally, internal variable, external variable, and intention scores all significantly increased in the patients who viewed the educational video compared to patients who did not. This study, within the context of the IBM, has identified important internal and external variables that significantly impacted the intention to perform MRSA decontamination. Although the empiric data that was obtained in this patient cohort is well supported within the context of the IBM, further research will need to be performed to verify these findings on a larger patient population.