Eliminating Staphylococcus aureus colonisation prior to surgery through screening and decolonisation measures in the outpatient setting: how well does outpatient decolonisation work in practice from the patients’ perspective?

BACKGROUND: Although 90% of Staphylococcus aureus (SA) cases in hospitals are community acquired, decolonisation strategies primarily target inpatients. The Preoperative Detection and Decolonisation for the Prevention of Staphylococcus aureus Complications in Elective Patients (STAUfrei) project explored an intersectoral approach with outpatient screening and decolonisation prior to hospitalisation. This study examined feasibility, patient adherence, and its link to decolonisation success. METHODS: Of 8054 patients (aged >18 years) with planned surgery at a hospital in southwest Germany, all intervention patients (N=3390) with a positive SA result at enrolment between 2019 and 2022 were invited to participate in a sub-study. Data were collected via a questionnaire and decolonisation diary. Colonised patients completed a five-day regimen with measures administered three times daily. Questionnaire data were analysed descriptively; the association between adherence and colonisation at admission was assessed via logistic regression. RESULTS: A total of 2147 patients participated in the survey. For analysis, only those with at least one decolonisation diary entry and a positive SA result at baseline were included (N=588). Patient acceptance of decolonisation measures was high: 86.9% reported good to very good implementability, and most considered both the duration (87.4%) and daily effort (78.7%) acceptable. A quarter adhered to over 80% of the measures, while only 6.6% achieved full adherence. Adherence was lowest at mid-day. Higher adherence was linked to lower colonisation rates, though not statistically significant. CONCLUSION: Questionnaire data showed high feasibility and adherence to home-based decolonisation. Higher adherence was linked to lower colonisation rates at admission. Further research is needed to define the optimal composition of effective outpatient measures.