Total joint arthroplasty patients' adherence to a pre-operative staphylococcus aureus decolonization protocol

Background: Staphylococcus aureus surgical site infections and their treatment, in the total joint arthroplasty population, can significantly affect patients’ recovery and their quality of life, and can generate considerable economic cost for the health care system. The use of a pre-operative screening and decolonization protocol has shown promising eradication rates of Staphylococcus aureus and a decreased incidence of surgical site infections, however, the results have lacked statistical significance. Adherence to the decolonization protocol has been identified as a possible missing link or explanation for these equivocal findings. Objective: The purpose of this study was to examine the relationships between age, self-efficacy, and adherence to a Staphylococcus aureus screening and decolonization protocol in the total joint arthroplasty population. Methods: A descriptive correlational study design was conducted. The study sample included 40 participants who underwent primary total joint arthroplasty surgery between May 1, 2013 and October 1, 2013 at a hospital in Vancouver, British Columbia. Self-efficacy and adherence were assessed using two self-report measures: the Self-efficacy Survey and the Adherence Questionnaire. Data were analyzed using correlational and multiple linear regression analyses. Results: The findings suggest that there was a positive relationship between age and adherence to the use of chlorhexidine gluconate cloths, and a negative relationship between age and adherence to the use of nasal Mupirocin. These results were not statistically significant. There was a statistically significant and strong positive relationship between the patients’ level of self-efficacy in applying Mupirocin and their adherence to its use, timing, and application. Little if no relationship was found between the patients’ level of self-efficacy to chlorhexidine gluconate cloths and their adherence to its use, timing, and application. Age, and not self-efficacy, contributed significantly to the outcome, adherence. Conclusions: The study found inconclusive results with respect to the relationships between age, self-efficacy, and adherence. In light of these results, this study highlights the many ways in which age and self-efficacy can influence adherence in adults. This information can be useful when evaluating the effectiveness of a decolonization protocol and for nurses in their attempts to design, implement, and evaluate patient education materials relevant to the protocol.Applied Science, Faculty ofNursing, School ofGraduat