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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng125er1-lrg.png" alt="Cover of Evidence review for effectiveness of nasal decolonisation in prevention of surgical site infection" /></a><div class="icnblk_cntnt"><h1 id="_NBK569834_"><span itemprop="name">Evidence review for effectiveness of nasal decolonisation in prevention of surgical site infection</span></h1><div class="subtitle">Surgical site infections: prevention and treatment</div><p><b>Evidence review A</b></p><p><i>NICE Guideline, No. 125</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 Apr</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3394-5</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="ch1.s1"><h2 id="_ch1_s1_">Effectiveness of nasal decolonisation in the prevention of surgical site infection</h2><div id="ch1.s1.1"><h3>Review question</h3><p>Does the use of nasal decolonisation to eliminate <i>Staphylococcus aureus</i> (alone or in combination with other interventions) affect the rate of surgical site infection?</p><p>Two further sub-questions were answered in the update:
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<ul id="ch1.l1"><li id="ch1.lt1" class="half_rhythm"><div>What is the contribution to clinical effectiveness of the timing of nasal decolonisation for the prevention of surgical site infection?</div></li><li id="ch1.lt2" class="half_rhythm"><div>What is the cost-effectiveness of different nasal decolonisation interventions for the prevention of surgical site infection caused by <i>S. aureus</i>?</div></li></ul></p><div id="ch1.s1.1.1"><h4>Introduction</h4><p><i>Staphylococcus aureus (S. aureus)</i> is the most common cause of surgical site infections (SSIs) in all types of surgery. Topical antimicrobial agents which are active against <i>S. aureus</i> can be utilised to decolonise patients prior to surgery.</p><p>The 2008 NICE guideline on the prevention and treatment of surgical site infection recommended against the use of nasal decontamination with topical antimicrobial agents for the elimination <i>S. aureus</i> to reduce the risk of surgical site infection. This decision was driven by the evidence which demonstrated that mupirocin or chlorhexidine nasal decontamination did not reduce the overall rate of SSI.</p><p>The topic was reviewed in 2017 by NICE’s surveillance team and new evidence was identified which examined the use of nasal decolonisation for the elimination of <i>S. aureus</i>, and thus prompted a partial update of guideline. This review aims to determine the clinical and cost effectiveness of nasal decolonisation using topical antimicrobial agents for the prevention of SSIs with or without the combined use of chlorhexidine body wash or glycopeptide prophylaxis. Timing of nasal decolonisation for the prevention of SSI will also be examined.</p><p>This review identified studies that fulfilled the conditions specified in PICO table. For full details of the review protocol, see <a href="#ch1.appa">appendix A</a>.</p></div><div id="ch1.s1.1.2"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>
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<u>(2014)</u>. The review protocol for this review question is in <a href="#ch1.appa">appendix A</a>. Methods specific to this review question are described in the review protocol in <a href="#ch1.appb">appendix B</a>.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/Media/Default/About/Who-we-are/Policies-and-procedures/declaration-of-interests-policy.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s 2018 conflicts of interest policy</a>.</p><p>A search strategy was used to identify all studies that examined the effectiveness of different antimicrobial agents (outlined in <a class="figpopup" href="/books/NBK569834/table/ch1.appb.tab3/?report=objectonly" target="object" rid-figpopup="figch1appbtab3" rid-ob="figobch1appbtab3">Table 1</a>) which are used for nasal decolonisation prior to surgery to reduce the risk of SSIs. Randomised control trials (RCTs) and systematic reviews of RCTs were considered for inclusion. The review protocol also specified that in the event of less than 5 RCTs being identified, quasi-randomised trials would also be considered for inclusion.</p><p>Studies were also excluded if they:
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<ul id="ch1.l6"><li id="ch1.lt20" class="half_rhythm"><div>Included patients undergoing a surgical procedure that does not involve a visible incision and therefore does not result in the presence of a conventional surgical wound</div></li><li id="ch1.lt21" class="half_rhythm"><div>Were not in English</div></li><li id="ch1.lt22" class="half_rhythm"><div>Were not full reports of the study (for example, published only as an abstract)</div></li></ul></p><p>The studies included in this review examined different populations, types of surgery and timing of nasal decolonisation. The evidence statements produced reflect these differences.</p><p>According to the Centres for Disease Control and Prevention (CDC) a SSI is defined as an infection occurring within 30 days after operation. A deep SSI is defined as an infection which occurs within 30 days after the operation if no implant is left in place, or within 1 year if implant is placed. Therefore SSI within 30 days and 1 year were prioritised in this review.</p><p>Follow-up of SSI varied among the studies that were included in the review. Where possible sub-group analyses were conducted based on follow-up period (for example at 30 days after surgery and within 8 weeks of surgery) and this information was incorporated into the evidence statements.</p></div><div id="ch1.s1.1.3"><h4>Clinical evidence</h4><div id="ch1.s1.1.3.1"><h5>Included studies</h5><p>From a database of 835 studies, 70 studies were identified as being potentially relevant. Following full text review of the 70 studies, 9 RCTs were included which examined the following interventions:
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<ul id="ch1.l7"><li id="ch1.lt23" class="half_rhythm"><div>mupirocin versus placebo nasal ointment</div></li><li id="ch1.lt24" class="half_rhythm"><div>mupirocin versus no nasal decolonisation</div></li><li id="ch1.lt25" class="half_rhythm"><div>mupirocin versus 5% povidone iodine</div></li><li id="ch1.lt26" class="half_rhythm"><div>mupirocin in combination with chlorhexidine body wash versus no treatment (no nasal decolonisation or body wash)</div></li><li id="ch1.lt27" class="half_rhythm"><div>mupirocin in combination with chlorhexidine body wash versus placebo (placebo ointment in combination with placebo soap)</div></li><li id="ch1.lt28" class="half_rhythm"><div>nasal chlorhexidine versus placebo.</div></li></ul></p><p>No studies of relevant study design were identified which examined the effectiveness of chlorhexidine and neomycin cream or octenisan nasal gel. No studies were identified which compared the timing of nasal decolonisation.</p><p>The included studies explored a number of different outcomes. Data on overall SSI (irrespective of pathogen) and <i>S. aureus</i> SSI was extracted. Where possible, data on superficial, deep and organ space occupying SSI were extracted. Data on methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) and Methicillin-sensitive <i>Staphylococcus aureus</i> (MSSA) specific SSI were also extracted.</p><p>Studies included in this review also examined a number of different surgical procedures. However, sufficient evidence was not identified to conduct sub-group analyses based on wound classification, elective surgery or emergency surgery.</p><p>Comparative evidence was not identified in terms of antimicrobial resistance. However the information presented in the studies was discussed with the committee and added to the rational and impact section.</p><p>For the search strategy, see <a href="#ch1.appc">appendix C</a>. For clinical evidence study selection flowchart, see <a href="#ch1.appd">appendix D</a>.</p></div><div id="ch1.s1.1.3.2"><h5>Excluded studies</h5><p>List of papers excluded at full text, with reasons, is given in <a href="#ch1.appk">Appendix K</a>.</p></div></div><div id="ch1.s1.1.4"><h4>Summary of clinical studies included in the evidence review</h4><p>The included studies are summarised in <a class="figpopup" href="/books/NBK569834/table/ch1.tab2/?report=objectonly" target="object" rid-figpopup="figch1tab2" rid-ob="figobch1tab2">Table 2</a> below. See <a href="#ch1.appe">appendix E</a> for full evidence tables.</p></div><div id="ch1.s1.1.5"><h4>Quality assessment of clinical studies included in the evidence review</h4><p>All studies included in the review were RCTs. The quality of the evidence was initially graded as high. A number of studies demonstrated unclear blinding of participants and personnel. However, these studies were not downgraded in this domain as the outcome measures were objective. Studies were mainly downgraded for unclear random sequence generation, allocation concealment, blinding of outcome assessment or for the conduction of ‘as treated’ analysis as opposed to intention to treat.</p><p>Studies included in the review classified infections using the Centres for Disease Control and Prevention (CDC) SSI criteria as well as the Nosocomial Infection Surveillance System definitions. The follow–up period within studies also ranged from 30 days to 1 year. Studies which did not specify the criteria used to classify infections or follow-up period were downgraded for serious indirectness.</p><p>One study was also downgraded for indirectness for the use of chlorhexidine as a mouth wash as well as a nasal gel. See <a href="#ch1.appg">appendix G</a> for full GRADE tables and <a href="#ch1.appf">appendix F</a> for forest plots in situations where data have been meta-analysed.</p></div><div id="ch1.s1.1.6"><h4>Economic evidence</h4><div id="ch1.s1.1.6.1"><h5>Included studies</h5><p>A literature search was conducted to identify cost–utility analyses comparing nasal decolonisation interventions. Nasal decolonisation may be conditional on the results of a diagnostic test to support decision-making in some settings, and so studies that evaluated ‘screen and treat’ strategies were included. Standard health economic filters were applied to a clinical search, returning a total of 536 citations. Following review of all titles and abstracts, 25 studies were identified as being potentially relevant to this decision problem, and were ordered for full review. After reviewing the full texts, 3 studies were included as economic evidence for nasal decolonisation.</p></div><div id="ch1.s1.1.6.2"><h5>Excluded studies</h5><p>Studies that were excluded upon full review are listed in <a href="#ch1.appk">Appendix K</a>, including the primary reason for exclusion.</p></div></div><div id="ch1.s1.1.7"><h4>Summary of studies included in the economic evidence review</h4><p>A summary of each of the 3 studies included as economic evidence is provided below. Full economic evidence tables for each study are provided in <a href="#ch1.appi">Appendix I</a>. A summary economic evidence profile is provided in <a href="#ch1.appj">Appendix J</a>.</p><div id="ch1.s1.1.7.1"><h5>Courville et al. (2012)</h5><p>Courville et al. (2012) developed a 1-year decision-tree model to evaluate the cost-effectiveness of preoperative nasal mupirocin, given for 5 days, to prevent SSI in people undergoing total hip or knee arthroplasty in the US. The comparators were: (1) preoperative screening cultures for all patients and treat those positive for <i>S. aureus</i>; (2) treat everybody without screening; and (3) do not provide any screening or treatment. Clinical inputs were sourced from a systematic literature review, with an SSI relative risk of 0.61 with mupirocin in <i>S. aureus</i> carriers (26% prevalence). Screening sensitivity and specificity were 0.52 and 0.85, respectively. The authors assumed that an SSI required a full hip or knee revision procedure. An SSI reduced a person’s quality of life utility value by 20%.</p><p>The ‘treat all’ mupirocin strategy was found to dominate the restricted treatment strategies in both the hip and knee arthroplasty populations, providing a small gain in quality-adjusted life-years (QALYs) per patient (0.0002 to 0.0005) and lower overall costs (saving £151 to £205) over 1 year. Treating all patients continued to dominate in the majority of univariate sensitivity analyses, unless the cost of SSI revision surgery was low (close to that of the primary arthroplasty procedure), or if the SSI relative risk with mupirocin was 0.99. In this latter scenario the ‘no treatment’ strategy becomes dominant, though it lies outside the range of values that the authors identified in the literature (0.10 to 0.64). The screening strategy was not found to be cost effective in any alternative scenario.</p></div><div id="ch1.s1.1.7.2"><h5>Wassenberg et al. (2011)</h5><p>Wassenberg et al. (2011) evaluated the cost-effectiveness of preoperative nasal mupirocin with chlorhexidine soap, given for 5 days, to prevent deep SSI in people undergoing joint implant or cardiac surgery in the Netherlands. The comparators were: (1) do not provide any screening or treatment; (2) screen all patients with rapid PCR and culture, and treat those positive for <i>S. aureus</i>; and (3) treat everybody with mupirocin, without screening. Screening was modelled as being highly effective, with sensitivity of 0.97 and specificity of 0.99. Records from 1 hospital during the period 2001 to 2010 were reviewed to quantify hospital costs and mortality associated with a deep SSI, with data from 53 SSIs out of approximately 1,200 procedures per year. Life-expectancy was discounted by 3% per year, but SSI costs were all incurred within 1 year of the primary procedure. The deep SSI relative risk of mupirocin was 0.21 in <i>S. aureus</i> carriers (18% prevalence) (<a class="bk_pop" href="#ch1.appl.ref1">Bode et al., 2010</a>).</p><p>The ‘treat all’ mupirocin strategy was found to dominate both restricted treatment strategies. Treating all patients produced an additional 0.010 discounted life-years per patient compared with the screen and treat strategy, and 0.024 more than the no treatment strategy. The total cost saving was estimated to be £41 and £114 per patient, over the screening and no treatment strategies respectively. Sensitivity analysis showed that the ‘treat all’ strategy, without screening, remained cost-saving if the SSI relative risk with mupirocin was worse than the base-case estimate (0.60 instead of 0.21).</p></div><div id="ch1.s1.1.7.3"><h5>Young & Winston (2006)</h5><p>The US modelling analysis by Young & Winston (2006) was included in the original guideline. The 90-day decision-tree model compared preoperative mupirocin in elective surgery (cardiothoracic, neurologic, gynaecologic and general), given for 5 days according to the following strategies: (1) screen with nasal culture and treat screen-positive individuals; (2) treat all patients without screening; and (3) do not provide any screening or treatment. Clinical inputs were sourced from a systematic literature review, using RCTs where available. The SSI relative risk with mupirocin was 0.49 in <i>S. aureus</i> (23% prevalence). Screening appears to have been assumed to be 100% accurate. Direct healthcare costs were sourced from the literature review where possible, otherwise Medicare charges were used. Patient productivity loss costs were included, however, they were likely to have been an inconsequential component of total costs.</p><p>The ‘screen and treat’ mupirocin strategy was found to dominate both of the other strategies. It prevented 86 SSIs and 2 deaths per 10,000 patients compared with no treatment, and treating all patient was not more effective at reducing the incidence of SSI. Its total cost saving compared with the ‘treat all’ strategy was estimated to be $14 (£10) per patient, or $8 (£6) per patient if only hospital costs are included, due to avoiding unnecessary treatment costs. One-way sensitivity analysis found that mupirocin efficacy was the only parameter likely to influence cost-effectiveness results; an SSI relative risk with mupirocin of 0.92 makes the ‘treat all’ strategy incur higher costs than ‘no treatment’, with a cost per life-year gained of $389,782 (£277,000).</p></div></div><div id="ch1.s1.1.8"><h4>Economic model</h4><p>The committee advised that the cost effectiveness of nasal decontamination of <i>S. aureus</i> is an area of uncertainty, and that any recommendations may have a significant impact on NHS practice. This question was therefore prioritised for new economic modelling</p><div id="ch1.s1.1.8.1"><h5>Model methods</h5><p>A decision-tree model was developed, adopting a very similar structure to the model developed for the initial guideline. The model captures the short-term decision about whether to use nasal decontamination. At model entry a patient has just undergone a surgical procedure, from which they are subject to a risk of SSI and mortality. For the purpose of this decision problem, the model focuses on SSIs caused by <i>S. aureus</i>. After the perioperative period, the model applies age-related life expectancy to surviving patients. In this way, the full impact of any SSI-related mortality on health gains are captured. The model takes a patient perspective for outcomes and an NHS and PSS perspective for costs, in line with the NICE manual for guideline development (NICE 2014). Long-term outcomes are discounted at a rate of 3.5% per year.</p><p>The model includes 3 comparators: universal decolonisation using mupirocin; decolonisation with mupirocin in people who are screened positive for nasal carriage of <i>S. aureus;</i> and no decolonisation at all (standard care only). Standard care is assumed to capture general infection control measures, such as a chlorhexidine body wash. Mupirocin is the only active intervention included, as this was the focus of almost the entire body of clinical evidence. The screen-and-treat strategy was included as the committee felt that the decision to use nasal decontamination of <i>S. aureus</i> is intrinsically linked with knowledge about whether the person is a carrier of <i>S. aureus</i> or not.</p><p>Baseline <i>S. aureus</i> SSI rates were obtained from 2 UK sources: a surveillance study in an English hospital in the base-case analysis (Jenks et al., 2014), and a national registry (PHE, 2017) in a scenario analysis. The committee expressed a strong preference for the hospital study, advising that its higher SSI rates (5.1% overall, compared with 1.3%) are more representative of outcomes in current practice and their own experiences. In this study, 33% of SSIs were caused by <i>S. aureus,</i> compared with 11% in the PHE SSI surveillance service data (although this estimate relates to inpatient-detected SSIs only; for inpatient and readmission-detected SSIs, the proportion is 20%). These data were used to inform baseline <i>S. aureus</i> SSI rates without nasal decontamination, for 17 different types of surgery as well as a pooled ‘all surgery’ cohort. As the screening strategy will provide information about whether a person is a <i>S. aureus</i> carrier or non-carrier, it was necessary to adjust the baseline infection rate to reflect this distinction, as the Jenks and PHE data are in general surgical populations composed of some carriers and some non-carriers. To do so, we used RCT control-arm data to obtain odds ratios for <i>S. aureus</i> SSI incidence in carriers and non-carriers compared with the general surgical population (2.4 and 0.6 respectively; Kalmeijer et al., 2006; <a class="bk_pop" href="#ch1.appl.ref4">Perl et al., 2002</a>).</p><p>Treatment effects were informed by pooling the 5 mupirocin RCTs identified in the clinical review that report <i>S. aureus</i> SSI rates in carriers, comparing mupirocin with placebo or no nasal decontamination (<a class="bk_pop" href="#ch1.appl.ref1">Bode et al., 2010</a>; <a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer et al., 2002</a>; <a class="bk_pop" href="#ch1.appl.ref3">Konvalinka et al., 2006</a>; <a class="bk_pop" href="#ch1.appl.ref4">Perl et al., 2002</a>; <a class="bk_pop" href="#ch1.appl.ref9">Tai et al., 2013</a>). The mupirocin pooled odds ratio was found to be 0.47 (0.31 to 0.70) in a fixed-effect analysis, and 0.47 (0.30–0.73) in a random-effects analysis. Excluding an RCT in the highly-specialised Mohs surgery setting (<a class="bk_pop" href="#ch1.appl.ref9">Tai et al., 2013</a>) and another that was unclear about its use of a chlorhexidine wash on the control arm (Kalmeijer et al., 2006) had little impact on these odds ratios (0.50 and 0.53). The mupirocin odds ratios were applied in the model to treated <i>S. aureus</i> carriers, whose prevalence was set to 25% of the surgical population, informed by a UK observational study (den Heijer et al., 2013). On the universal mupirocin model arm, non-carriers treated with mupirocin were assumed to experience no treatment effect on their risk of <i>S. aureus</i> SSI. On the screening arm, only correctly-identified carriers (true-positive results) received the treatment effect. A full diagnostic accuracy literature search was not conducted for this review; therefore the inputs used in the model for the initial guideline were used for these data. In the base-case analysis, a nasal swab and culture with sensitivity of 0.68 and specificity of 0.95 was applied. A scenario analysis applied the superior, but more expensive, polymerase chain reaction (PCR) test (sensitivity 0.98, specificity >0.99).</p><p>Resource use inputs include the cost associated with intervention: mupirocin (£4.24; NHS Drug Tariff VIIIA, May 2018) and screening (£10–29 including nurse time; guideline committee and original guideline model). The committee advised that mupirocin is self-administered by the person due to undergo surgery; therefore no administration cost was applied. For SSI costs, data on excess bed days attributable to an SSI across different types of surgery was obtained from the English hospital study (Jenks et al., 2014), and was costed using NHS reference costs 2016–17. The average SSI cost is £3,123, ranging from £823 to £9,056.</p><p>Recent evidence suggests there might not be a significant mortality effect attributable to SSI (Badia et al., 2017); however, the committee felt that such an effect is very likely to exist, but that it is difficult to quantify. We estimated a mortality odds ratio associated with SSI compared with no SSI of 1.5 (0.8 to 4.1), based on the UK SSI surveillance data used in the original guideline model (Coello et al., 2005). This was applied to baseline mortality rates by surgery type, from the PHE (2017) data, to estimate separate mortality rates in people who experience an SSI and those who do not. People who survive are assumed to experience typical, age-related life expectancy and quality of life after the surgical period, informed by UK population norms (ONS, 2017; Kind et al., 1999). The impact of an infection on quality of life is informed by a UK EQ-5D study in people undergoing laparotomy (Pinkney et al., 2013), which found that people will an SSI report a bigger utility loss at 7 days (−35% vs. −33%) and 30 days (−17% vs. −6%). We linearly interpolated that it will take people who have an SSI 22 additional days to fully recover to baseline quality of life, compared with 6 additional days for people who do not have an SSI. These effects are applied as a one-off QALY loss.</p></div><div id="ch1.s1.1.8.2"><h5>Model results</h5><p>Base-case model results, across all types of surgery for a cohort aged 70 and 42% male (PHE, 2017), suggest that universal nasal decolonisation of <i>S. aureus</i> with mupirocin is cost effective, dominating both the screen-and-treat and no treatment strategies (Table ). It produces the highest number of QALYs as it ensures that all <i>S. aureus</i> carriers receive nasal decontamination, and there is no negative health effect caused by treating non-carriers. The cost of treating everybody is more than offset by not screening people and reducing the incidence of SSI. Probabilistic sensitivity analysis from 1,000 model runs indicates that universal mupirocin has a 99.6% probability of being cost-effective when QALYs are valued at £20,000 each.</p><p>Providing nasal decontamination only to people who screen positive for <i>S. aureus</i> has a 0% probability of being optimal. One-way sensitivity analysis showed that results are sensitive to baseline <i>S. aureus</i> SSI rates; if much lower infection rates are used, from the PHE (2017) registry, universal mupirocin is no longer cost-effective compared with providing no nasal decontamination (<a class="figpopup" href="/books/NBK569834/figure/ch1.fig1/?report=objectonly" target="object" rid-figpopup="figch1fig1" rid-ob="figobch1fig1">Figure 1</a>). No other individual model parameter or setting – for example, reducing mupirocin efficacy to its 95% confidence interval limit (odds ratio: 0.70), or assuming that mupirocin requires nurse-led administration – affects the base case model result.</p><p>In subgroup analysis, the base case result was found to be largely consistent across different types of surgery. The only specialties in which universal mupirocin was not the dominant strategy were breast surgery (ICER vs. standard care: £849 per QALY gained) and cranial surgery (ICER vs. standard care: £13,089 per QALY gained). The respective probabilities of its ICER being £20,000 or better are 76% and 65%. This probability is 67% in spinal surgery, though mupirocin was dominant in the deterministic result. Across all other types of surgery the probability of mupirocin being cost-effective, when a QALY is valued at £20,000, is 89% or higher.</p></div></div><div id="ch1.s1.1.9"><h4>Evidence statements</h4><p>The format of the evidence statements is explained in the methods in <a href="#ch1.appb">appendix B</a>. Evidence statements were also stratified by population.</p><div id="ch1.s1.1.9.1"><h5>Clinical evidence</h5><p>Evidence identified in the review explored a number of different surgical procedures and timing of decolonisation. Where possible, evidence statements were constructed to reflect these characteristics. Evidence statements were stratified based on different populations.</p><div id="ch1.s1.1.9.1.1"><h5>Mupirocin versus placebo</h5><div id="ch1.s1.1.9.1.1.1"><h5>Outcomes in whole population undergoing surgery</h5><ul id="ch1.l44"><li id="ch1.lt135" class="half_rhythm"><div>Low quality evidence from 2 RCTs, including 4,478 people could not differentiate overall SSI at 30 days between people who received mupirocin and those who received placebo before undergoing surgery.</div></li><li id="ch1.lt136" class="half_rhythm"><div>Low to very low quality evidence from 1 RCT, including 614 people could not differentiate the following outcomes between people who received mupirocin a day before orthopaedic surgery and those who received placebo:
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<ul id="ch1.l45" class="circle"><li id="ch1.lt137" class="half_rhythm"><div>Overall Superficial SSI at 30 days</div></li><li id="ch1.lt138" class="half_rhythm"><div>Overall Deep SSI at 30 days</div></li><li id="ch1.lt139" class="half_rhythm"><div>Hospital readmission</div></li><li id="ch1.lt140" class="half_rhythm"><div>Mean hospital stay</div></li></ul></div></li><li id="ch1.lt141" class="half_rhythm"><div>Low quality evidence from 2 RCTs, including 4,400 people could not differentiate <i>S. aureus</i> SSI at 30 days between people who received mupirocin and those who received placebo before undergoing surgery.</div></li><li id="ch1.lt142" class="half_rhythm"><div>Moderate quality evidence from 1 RCT, including 3,864 people could not differentiate overall nosocomial infections defined as bloodstream, respiratory tract, catheter and surgical site infections within 30 days between people who received mupirocin 5 days before surgery and those who received placebo.</div></li><li id="ch1.lt143" class="half_rhythm"><div>Low quality evidence from 1 RCT, including 3,370 people could not differentiate <i>S. aureus</i> nosocomial infections defined as bloodstream, respiratory tract, catheter and surgical site infections within 30 days between people who received mupirocin 5 days before surgery and those who received placebo.</div></li></ul></div><div id="ch1.s1.1.9.1.1.2"><h5>Outcomes in <i>S. aureus</i> carriers undergoing surgery</h5><ul id="ch1.l46"><li id="ch1.lt144" class="half_rhythm"><div>Low quality evidence from 1 RCT, including 869 <i>S. aureus</i> carriers, indicated that people who received mupirocin 5 days before surgery had a lower incidence of <i>S. aureus</i> nosocomial infections at 30 days after surgery compared with those who received placebo.</div></li><li id="ch1.lt145" class="half_rhythm"><div>Very low quality from evidence from 2 RCTs, including 1,148 <i>S. aureus</i> carriers could not differentiate overall SSI between people who received mupirocin compared to those who received placebo before surgery.</div><ul id="ch1.l47" class="circle"><li id="ch1.lt146" class="half_rhythm"><div>Low quality evidence from 1 RCT could not differentiate overall SSI at 30 days</div></li><li id="ch1.lt147" class="half_rhythm"><div>Low quality evidence from 1 RCT could not differentiate overall SSI within 8 weeks of surgery.</div></li></ul></li><li id="ch1.lt148" class="half_rhythm"><div>Low quality evidence from 1 RCT, including 257 <i>S. aureus</i> carriers could not differentiate the following outcomes between people who received mupirocin 7 days before cardiac surgery and those who received placebo:
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<ul id="ch1.l48" class="circle"><li id="ch1.lt149" class="half_rhythm"><div>Overall superficial SSI within 8 weeks of surgery</div></li><li id="ch1.lt150" class="half_rhythm"><div>Overall deep SSI within 8 weeks of surgery</div></li><li id="ch1.lt151" class="half_rhythm"><div>Overall deep space occupying SSI within 8 weeks of surgery</div></li><li id="ch1.lt152" class="half_rhythm"><div>Mortality within 8 weeks of surgery.</div></li></ul></div></li><li id="ch1.lt153" class="half_rhythm"><div>Low quality evidence from 1 RCT, including 891 <i>S. aureus</i> carriers could not differentiate overall nosocomial infections defined as bloodstream, respiratory tract, catheter and surgical site infections within 30 days between people who received mupirocin 5 days before surgery and those who received placebo.</div></li><li id="ch1.lt154" class="half_rhythm"><div>Moderate quality evidence from 3 RCTs, including 1,318 <i>S. aureus</i> carriers could not differentiate <i>S. aureus</i> SSI between people who received mupirocin and those who received placebo before undergoing surgery.</div><ul id="ch1.l49" class="circle"><li id="ch1.lt155" class="half_rhythm"><div>Very low quality evidence from 2 RCTs could not differentiate <i>S. aureus</i> SSI at 30 days</div></li><li id="ch1.lt156" class="half_rhythm"><div>Low quality evidence from 1 RCT could not differentiate <i>S. aureus</i> SSI within 8 weeks of surgery</div></li></ul></li></ul></div></div><div id="ch1.s1.1.9.1.2"><h5>Mupirocin versus no nasal decolonisation</h5><div id="ch1.s1.1.9.1.2.1"><h5>Outcomes in whole population undergoing surgery</h5><ul id="ch1.l50"><li id="ch1.lt157" class="half_rhythm"><div>Moderate to low quality evidence from 1 RCT, including 395 people could not differentiate the following outcomes between people who received mupirocin 3 days before digestive surgery and those who received no nasal decolonisation:
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<ul id="ch1.l51" class="circle"><li id="ch1.lt158" class="half_rhythm"><div>Overall SSI at 30 days</div></li><li id="ch1.lt159" class="half_rhythm"><div>Overall superficial SSI at 30 days</div></li><li id="ch1.lt160" class="half_rhythm"><div>Overall deep SSI at 30 days</div></li><li id="ch1.lt161" class="half_rhythm"><div>S. aureus SSI at 30 days</div></li><li id="ch1.lt162" class="half_rhythm"><div>Overall nosocomial infections at 30 days.</div></li></ul></div></li></ul></div></div><div id="ch1.s1.1.9.1.3"><h5>Mupirocin versus 5% povidone iodine</h5><div id="ch1.s1.1.9.1.3.1"><h5>In whole population</h5><p>Low to very low quality evidence from 1 RCT, including 1,697 people could not differentiate the following outcomes between people who received mupirocin 5 days before arthroplasty or spine fusion surgery and those who received 5% povidone iodine:
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<ul id="ch1.l52" class="circle"><li id="ch1.lt163" class="half_rhythm"><div>Overall deep SSI within 3 months of surgery</div></li><li id="ch1.lt164" class="half_rhythm"><div><i>S. aureus</i> deep SSI within 3 months of surgery</div></li><li id="ch1.lt165" class="half_rhythm"><div>MRSA deep SSI within 3 months of surgery</div></li><li id="ch1.lt166" class="half_rhythm"><div>MSSA deep SSI within 3 months of surgery.</div></li></ul></p></div></div><div id="ch1.s1.1.9.1.4"><h5>Mupirocin in combination with chlorhexidine body wash versus no treatment</h5><div id="ch1.s1.1.9.1.4.1"><h5>Outcomes in <i>S. aureus</i> carriers undergoing surgery</h5><p>Low quality evidence from 1 RCT, including 203 <i>S. aureus</i> carriers indicated that people who received mupirocin in combination with chlorhexidine body wash 5 days before Mohs surgery had lower incidence of MSSA SSI during the postoperative phase compared to people who received no nasal decolonisation and body wash. However, very low quality evidence, could not differentiate the following outcomes between the two groups:
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<ul id="ch1.l53" class="circle"><li id="ch1.lt167" class="half_rhythm"><div>S. aureus SSI during postoperative period</div></li><li id="ch1.lt168" class="half_rhythm"><div>MRSA SSI during postoperative period</div></li></ul>
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<ul id="ch1.l54"><li id="ch1.lt169" class="half_rhythm"><div>Very low quality evidence from 1 RCT, including 228 <i>S. aureus</i> carriers could not differentiate the following outcome after primary total hip or knee arthroplasty between people who received mupirocin in combination with chlorhexidine body wash at least a week before surgery and those who received no nasal decolonisation and body wash:
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<ul id="ch1.l55" class="circle"><li id="ch1.lt170" class="half_rhythm"><div>Overall deep SSI at 1 year</div></li><li id="ch1.lt171" class="half_rhythm"><div>S. aureus deep SSI at 1 year</div></li></ul></div></li></ul></p></div></div><div id="ch1.s1.1.9.1.5"><h5>Mupirocin in combination with chlorhexidine body wash versus placebo</h5><div id="ch1.s1.1.9.1.5.1"><h5>Outcomes in <i>S. aureus</i> carriers undergoing surgery</h5><ul id="ch1.l56"><li id="ch1.lt172" class="half_rhythm"><div class="half_rhythm">High quality evidence from 1 RCT, including 808 <i>S. aureus</i> carriers indicated that people who received mupirocin in combination with chlorhexidine body wash 5 days before surgery had lower incidence of the following outcomes compared to those who received placebo:
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<ul id="ch1.l57" class="circle"><li id="ch1.lt173" class="half_rhythm"><div><i>S. aureus</i> SSI until 6 weeks after discharge</div></li><li id="ch1.lt174" class="half_rhythm"><div><i>S. aureus</i> deep SSI until 6 weeks after discharge</div></li><li id="ch1.lt175" class="half_rhythm"><div><i>S. aureus</i> nosocomial infections until 6 weeks after discharge.</div></li></ul></div><div class="half_rhythm">However, moderate to low quality evidence, could not differentiate the following outcomes between the two groups:
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<ul id="ch1.l58" class="circle"><li id="ch1.lt176" class="half_rhythm"><div><i>S. aureus</i> superficial SSI until 6 weeks after discharge</div></li><li id="ch1.lt177" class="half_rhythm"><div>Mortality until 6 weeks after discharge</div></li><li id="ch1.lt178" class="half_rhythm"><div>Mortality in <i>S. aureus</i> carriers with infection until 6 weeks after discharge.</div></li></ul></div></li></ul></div></div><div id="ch1.s1.1.9.1.6"><h5>Chlorhexidine versus placebo</h5><div id="ch1.s1.1.9.1.6.1"><h5>Outcomes in whole population undergoing surgery</h5><ul id="ch1.l59"><li id="ch1.lt179" class="half_rhythm"><div class="half_rhythm">Moderate to low quality evidence from 1 RCT, including 954 people indicated that people who received chlorhexidine up to 4 times a day before cardiothoracic surgery had lower incidence of the following outcomes compared to those who received placebo:
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<ul id="ch1.l60" class="circle"><li id="ch1.lt180" class="half_rhythm"><div>Overall deep SSI at 30 days</div></li><li id="ch1.lt181" class="half_rhythm"><div>Overall nosocomial infections at 30 days</div></li><li id="ch1.lt182" class="half_rhythm"><div>Lower respiratory tract infection (LRTI) at 30 days</div></li><li id="ch1.lt183" class="half_rhythm"><div>Mean hospital stay.</div></li></ul></div><div class="half_rhythm">However, low to very low quality evidence, could not differentiate the following outcomes between the two groups:
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<ul id="ch1.l61" class="circle"><li id="ch1.lt184" class="half_rhythm"><div>Overall SSI at 30 days</div></li><li id="ch1.lt185" class="half_rhythm"><div>S. aureus SSI at 30 days</div></li><li id="ch1.lt186" class="half_rhythm"><div>Urinary tract infection (UTI) at 30 days</div></li><li id="ch1.lt187" class="half_rhythm"><div>Bacteraemia at 30 days</div></li><li id="ch1.lt188" class="half_rhythm"><div>Mortality at 30 days</div></li><li id="ch1.lt189" class="half_rhythm"><div>Hospital readmission.</div></li></ul></div></li></ul></div></div></div><div id="ch1.s1.1.9.2"><h5>Economic evidence</h5><ul id="ch1.l62"><li id="ch1.lt190" class="half_rhythm"><div>Three partially applicable economic evaluations with potentially serious limitations compared providing a 5-day course of preoperative intranasal mupirocin, to all patients and to patients screened positive for <i>S. aureus</i>, in various surgical settings, with providing no nasal decolonisation. Two studies found the universal treatment strategy to be more effective and cost-saving compared with the other options, while 1 study found the screen-and-treat strategy to be dominant. Conclusions were largely robust to one-way sensitivity analysis.</div></li><li id="ch1.lt191" class="half_rhythm"><div>A directly applicable economic model with minor limitations compared the use of mupirocin nasal ointment in all surgical patients with its use only in patients screened positive for <i>S. aureus</i> and with no nasal decolonisation. It found that universal mupirocin dominates other strategies in most types of surgery. Its ICER is better than £20,000 per QALY gained in all types, with likelihoods ranging from 65% to 100%. Results are sensitive to the baseline incidence of SSI; mupirocin is less likely to be cost effective if the underlying risk of SSI is very low.</div></li></ul></div></div><div id="ch1.s1.1.10"><h4>The committee’s discussion of the evidence</h4><div id="ch1.s1.1.10.1"><h5>Interpreting the evidence</h5><div id="ch1.s1.1.10.1.1"><h5>The outcomes that matter most</h5><p>The committee identified SSI including superficial SSI, deep SSI and organ space SSI as outcomes of interests. Studies included in the review captured SSI at different follow up periods. Based on the CDC definition of SSIs, the committee identified outcomes at 30 days and 1 year to be important.</p></div><div id="ch1.s1.1.10.1.2"><h5>The quality of the evidence</h5><p>Overall, the committee noted that the studies included in the review were of low to moderate quality. None of the studies included were conducted in the UK. Most of the studies provided old evidence with new evidence only being identified for the bundled use of intranasal mupirocin and chlorhexidine body wash.</p><p>One study [<a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>] provided high quality evidence which demonstrated a significant difference in the incidence of <i>S. aureus</i> SSI, <i>S. aureus</i> deep SSI and <i>S. aureus</i> nosocomial infections in <i>S. aureus</i> carriers who received intranasal mupirocin with chlorhexidine body wash, 4 days before surgery. However, the committee noted limitations with this data set. Firstly, while some studies [<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a> and <a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>] included data on both whole population and carrier population, <a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a> only included patients identified as high risk through real-time PCR (polymerase chain reaction).</p><p>Furthermore, the committee raised concerns about the classification of SSIs in this study. While the study states that CDC definitions were used to classify SSIs, the study only reported superficial and deep SSI. The study also only reported significant findings with regards for deep SSI. The committee noted that in some surgery types, for example colorectal surgery both superficial SSI and deep SSI occur. This study did include people undergoing gastrointestinal surgery, however it did not specify if any people underwent colorectal surgery specifically. The committee concluded that the study may have based on the occurrence of deep SSI as opposed to looking at both superficial and deep SSIs.</p><p>Additionally <a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a> only reported data on infections caused by <i>S. aureus</i>. While <i>S. aureus</i> is one of the most common microorganism associated with surgical site infections, infections can also be caused by other microorganisms such as <i>Staphylococcus epidermidis</i> (<i>S. epidermidis</i>). Similar to <a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>, <a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a> and <a class="bk_pop" href="#ch1.appl.ref9">Tai 2013</a> did not report data on infections caused by <i>S. epidermidis</i>. <a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>, <a class="bk_pop" href="#ch1.appl.ref5">Philips 2014</a> and <a class="bk_pop" href="#ch1.appl.ref7">Sousa 2016</a> all reported infections caused by other microorganisms such as <i>Pseudomonas aeruginosa</i> but did not specifically report data on infections caused by <i>S. epidermidis</i>. <a class="bk_pop" href="#ch1.appl.ref8">Suzuki 2003</a> did report that infections were caused by <i>S. epidermidis</i> along with <i>S. aureus</i>. While the focus of this review was on surgical site infections caused by <i>S. aureus,</i> information on infections caused by other microorganisms can also be useful.</p><p>A number of different surgical procedures were explored in this review, including cardiac surgery, orthopaedic surgery and knee arthroplasty. One study was identified [<a class="bk_pop" href="#ch1.appl.ref9">Tai 2013</a>] which included people undergoing Mohs surgery, which is a procedure used to treat skin cancer. While this study did demonstrate significant reduction in incidence of MSSA SSI, the committee identified that this study had a small sample size. Furthermore, the committee also noted that Mohs surgery is a niche procedure.</p><p>One study [<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>] was identified which examined the effectiveness of chlorhexidine gluconate. It should be noted that while this study identified a significant reduction in the incidence of overall deep SSI, overall nosocomial infections, lower respiratory tract infection and mean hospital stay, patients were administered chlorhexidine in the form of a gel for nasal application as well as an oral rinse. This study was downgraded for indirectness because of the use of the intervention as an oral rinse.</p></div><div id="ch1.s1.1.10.1.3"><h5>Benefits and harms</h5><p>Surgical site infections are associated with increased costs and poor patient outcomes. The consequence of SSIs varies between different surgical procedures and events can be detrimental in high-risk surgical procedures such as cardiac surgery. In such high risk procedures, consequences associated with SSIs are a major concern. Studies included in this review included people undergoing a number of different surgeries, including cardiac surgery.</p><p>The evidence base showed that the combined use of mupirocin with the use of chlorhexidine body wash did reduce the incidence of <i>S. aureus</i> SSI and deep SSI. Keeping in mind the consequences associated with SSIs, particularly in vulnerable people undergoing high risk surgical procedures, the committee noted the importance of decolonisation among these patients to provide protection against endogenous pathogens.</p><p>Due to the effectiveness of the combined use of mupirocin and chlorhexidine body wash in reducing <i>S. aureus</i> SSI the committee recommended for the combined use of mupirocin and chlorhexidine wash for nasal and whole body decolonisation prior to surgical procedures after which the risk of <i>S. aureus</i> SSI is high. The current recommendations do not explicitly outline which procedures should be considered as high risk. However, healthcare professionals should be aware of high risk surgeries within their Trusts and the consequences associated with SSIs with these surgical procedures.</p><p>The committee also identified mupirocin to the effective against <i>Staphylococcus epidermidis</i> (<i>S. epidermidis</i>), which is also associated with SSIs. This suggests that the use of mupirocin could potentially provide protection against other endogenous pathogens. However, it should be noted that the focus of this question was on <i>S. aureus</i> as evidence on <i>S. epidermidis</i> was not identified.</p><p>Topical use of mupirocin has been associated with side effects such as burning sensation and local reactions, however the frequency of side effects is not known. Caution should also be taken when using mupirocin on pregnant women and people who have moderate or severe renal impairment. It was also noted that chlorhexidine should not be used on people with existing skin conditions or those who have chlorhexidine sensitivity. There is also a potential risk of severe chemical injuries associated with the use of chlorhexidine solution in preterm neonates.</p><p>The committee acknowledged these adverse events and noted that that caution must be taken when considering the use of chlorhexidine body wash in patients presenting with contraindications. The committee also identified alternative interventions such as octenisan and polyhexanide that could be utilised instead of chlorhexidine. However, it should be noted that only studies examining the combined use of mupirocin and chlorhexidine body wash were identified. Due to this, no recommendations can be made on other nasal decolonisation protocols. Therefore, the committee identified this as an area which requires further research and made a research recommendation to reflect this.</p><p>In this review, antimicrobial resistance was identified as an important outcome as the committee identified resistance as a potential harm associated with the use of mupirocin and chlorhexidine body wash. No comparative data was identified, however three studies were identified which examined antimicrobial resistance. <a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>, which compared mupirocin with placebo, conducted in vitro susceptibility tests. The study found that 6 out of 1021 <i>S. aureus</i> isolates obtained from 6 patients, were resistant to mupirocin. Furthermore, the study reported that only 4 isolates were identified that were resistant to mupirocin, three of which were obtained from patients who were not treated with mupirocin.</p><p>Two further studies [<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a> and <a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>] were identified which also compared mupirocin with placebo. Both studies did not report tests which were conducted to ascertain resistance, but Kalmeijer concluded that none of <i>S. aureus</i> isolates were susceptible to mupirocin, while Konvalinka reported that none of the isolates from either nasal or wound culture were methicillin resistant. The committee noted that all three studies were based outside of the UK where antimicrobial resistance rates and policies were different. Therefore, this evidence was not identified are being compelling enough to stop the use of mupirocin for nasal decolonisation.</p><p>The committee also acknowledged that despite the extensive use of mupirocin over the last decade, resistance has not emerged. There is also active surveillance being conducted in the UK to capture data on resistance associated with the use of mupirocin. As the new recommendation allows healthcare professionals to consider the use of mupirocin, the committee noted that it is important that this surveillance is maintained to ensure any increase in resistance is registered. Therefore the committee made a recommendation for the maintenance of surveillance of antimicrobial resistance associated with mupirocin.</p><p>Furthermore, no evidence was identified which examined the antimicrobial resistance associated with the use of chlorhexidine body wash. The committee highlighted that a surveillance system has not been established to capture the increase in resistance associated with the use of chlorhexidine body wash. As the new recommendations allow healthcare professionals to consider the use of chlorhexidine body wash, the committee identified antimicrobial resistance associated with chlorhexidine as an important area of research. Therefore a research recommendation was developed to allow the establishment of a surveillance registry to examine the increase in resistance associated with the use of chlorhexidine.</p><p>The committee further noted that the combined used of mupirocin and chlorhexidine should only be considered when necessary and use should be based on MRSA and MSSA infection rates. Furthermore, as Trusts apply different dosage and duration of decolonisation in line with their own policies, existing decolonisation protocols should be taken into consideration when considering using the use of mupirocin and chlorhexidine body wash.</p><p>It should be acknowledged that the new recommendation does not support the use of mupirocin as part of standard care given to all patients but instead only administered to people who are undergoing procedures in which risk of <i>S. aureus</i> SSI is high. Considering the concerns with antimicrobial resistance, it is important that use of mupirocin and chlorhexidine body wash does not exceed recommended amount and prolonged and repetitive use is not advised.</p></div></div><div id="ch1.s1.1.10.2"><h5>Cost effectiveness and resource use</h5><p>The committee discussed the cost-effectiveness evidence for nasal decolonisation of <i>S. aureus</i>. It was noted that the 3 published studies included all found in favour of nasal decolonisation with mupirocin; however, all 3 were non-UK studies, limiting their applicability to NHS practice. It was agreed that this is particularly important for the estimated costs of treating an SSI, which are likely to be very high in the US studies. The committee agreed that the additional cost attributable to an SSI is likely to be much lower in the NHS. The committee discussed whether the Young & Winston (2006) study provides evidence that a strategy of screening people for <i>S. aureus,</i> and treating only those screen positive, is cost effective compared with giving mupirocin to all patients. It was noted that the study applied 100% diagnostic accuracy of screening, such that there is no health loss associated with failing to identify <i>S. aureus</i> carriers, and that this is therefore not strong evidence with which to recommend a strategy of nasal decolonisation only in <i>S. aureus</i> carriers.</p><p>The committee went on to discuss the economic model developed for this guideline, adopting a UK perspective, with resource use and cost inputs from directly relevant data-sources. It agreed that the resource use data, and the use of a UK EQ-5D study to inform the quality of life impact of SSI, made this analysis more applicable to the decision problem than the published studies. The committee agreed that the model should include a ‘screen-and-treat’ strategy, as knowledge about whether the person is a carrier of <i>S. aureus</i> will directly influence the decision regarding whether to provide nasal decolonisation of <i>S. aureus</i>.</p><p>The committee discussed the most appropriate way to characterise baseline SSI rates in the model, aware that the 2 main data-sources report disparate SSI rates. It heard that the PHE (2017) data suggest a relatively low underlying risk of SSI, compared with a considerably higher risk of SSI from the English hospital surveillance study (Jenks et al., 2014). The committee also recognised that European registry data appear to suggest SSI incidence rates closer to the PHE data than the Jenks et al. (2014) data. However, the committee expressed a strong preference for using the hospital surveillance data to inform baseline SSI risk, advising that these values are much more representative of clinical experience. The committee highlighted evidence in abdominal surgery trial control arms – which benefit from extensive trial follow-up – suggesting the SSI rate is over 20%, and so the Jenks data might still underestimate baseline SSI incidence (though being more accurate than the PHE data). It advised that a thorough hospital surveillance study is more likely to capture all SSIs across surgical specialties, and that this benefit of the Jenks study offsets its smaller sample size.</p><p>The committee reviewed the cost-effectiveness results from the new model, noting that universal nasal mupirocin – alongside standard infection control, including a chlorhexidine body wash – is highly likely to be an efficient use of resources in most surgical specialties. These results would have been even more strongly in favour of universal mupirocin if, based on committee experience, baseline SSI rates are higher than those reported in the Jenks et al. (2014) hospital surveillance data. In this respect the model results may in fact be conservative estimates of the cost effectiveness of mupirocin. The committee noted that the base-case result was largely robust to one-way sensitivity analysis and scenario analysis, including extreme values of <i>S. aureus</i> carriage prevalence. The only parameter of influence was the use of lower baseline SSI rates, from the PHE (2017) registry, instead of the hospital surveillance study. As noted above, the committee felt that the PHE values significantly underestimate the incidence of SSI, and that the Jenks et al. (2014) are likely to be more representative of current NHS outcomes.</p><p>The committee discussed whether it is plausible that a universal nasal decolonisation strategy would always provide the highest number of QALYs. The committee accepted that this was plausible, after agreeing that nasal mupirocin is not associated with important negative side effects, and screening measures are subject to imperfect sensitivity.</p><p>The committee discussed the results presented by type of surgery, observing that in 15 out of 17 specialties universal mupirocin remained dominant, consistent with the base-case ‘all surgery’ population. Mupirocin did not have an ICER worse than £20,000 per QALY gained in any of the 17 surgical subgroups. The most uncertain results were in cranial and spinal surgery, with 65% and 67% probabilities of mupirocin being cost effective respectively, due to their low underlying SSI risk and, in the case of cranial surgery, a low estimated additional resource use associated with SSI. The committee advised that, based on clinical experience, nasal decolonisation is sometimes currently used in breast surgery practice, which would make the baseline SSI incidence in breast surgery lower than if no nasal decolonisation were used. This may mean the non-dominant mupirocin ICER in breast surgery (£849 per QALY gained) is a conservative estimate. The committee also noted that the screen-and-treat strategy is very unlikely to be the optimal choice, even if the superior PCR test is used. This is consistent with the 2 published economic evaluations that assumed imperfect diagnostic accuracy.</p><p>The committee discussed the relative effectiveness evidence used in the model, which came from 5 pooled mupirocin RCTs which reported <i>S. aureus</i> SSI rates in <i>S. aureus</i> carriers. The committee advised that Mohs surgery is a highly specialised setting that is less representative of general surgical practice. It saw that excluding this trial (<a class="bk_pop" href="#ch1.appl.ref9">Tai et al., 2013</a>) from the pooled measure of effect did not influence cost-effectiveness conclusions. The committee noted that most of the clinical evidence included in this review, which had been separated in different ways, did not indicate a significant benefit associated with mupirocin, and agreed that this warrants a cautious approach to interpreting model results. Given this, the committee recommended that nasal decolonisation with mupirocin is considered, alongside a chlorhexidine body wash, replacing a previous recommendation advising against its use.</p></div><div id="ch1.s1.1.10.3"><h5>Other factors the committee took into account</h5><p>The secondary aim in this evidence review was to examine the timing of nasal decolonisation for the prevention of SSI. The committee noted that typically, mupirocin and chlorhexidine bundle is applied 2 days prior to surgery to 3 days after surgery. However no evidence was identified which explored timing of nasal decolonisation. Furthermore, timing of nasal decolonisation in the included studies ranged from five days before surgery to the day before surgery. Due to the lack of evidence, the committee were unable to comment on when mupirocin and chlorhexidine body wash should be administered. The committee did identify this as an important area which required further research as timing of decolonisation can vary and made a research recommendation to reflect this. Furthermore, as repetitive and prolonged use of antibiotics and antiseptics is not advised when taking into consideration antimicrobial resistance, understanding timing of decolonisation is crucial.</p><p>The PICO in <a class="figpopup" href="/books/NBK569834/table/ch1.appb.tab3/?report=objectonly" target="object" rid-figpopup="figch1appbtab3" rid-ob="figobch1appbtab3">Table 1</a> outlines that this review examined the effectiveness of a number of different interventions including chlorhexidine and neomycin cream (Naseptin) and octenisan nasal gel. However, no studies of relevant study design were identified which examined the effectiveness of these interventions. Therefore the committee were unable to make recommendations on the use of these interventions. The committee did consider these interventions in the three additional research recommendations made.</p><p>In this review evidence on people who had been identified as <i>S. aureus</i> carriers through screening and the whole population (in whom screening was not conducted) was identified. However, studies examining the combined use of mupirocin with chlorhexidine body wash only included people who had been identified as <i>S. aureus</i> carriers through screening. Due to the lack of information on the whole population, the committee identified this as an important area of further research.</p><p>The committee further noted that studies included in the review did not provide data on children. Due to the lack of evidence in this population, specific recommendations could not be made for this population group. Additionally, the committee identified risks associated with the use of chlorhexidine in preterm neonates. As data on alternative body washes was not identified, no recommendations could be made, however the committee identified this as an important area for research and made a research recommendation to examine the effectiveness of other nasal decolonisation protocols. It was also noted that children may find it difficult to tolerate nasal decolonisation. However, the recommendations state that use of nasal mupirocin should be used taking into account surgical procedure, patient risk factors and impact of infection. Therefore, clinicians should take age into their decision making process.</p><p>The committee also discussed that as decolonisation with mupirocin and chlorhexidine takes place prior to surgery, people may be required to self-administer the treatment. While some manufacturers may provide a guide to aid people with the procedure, people with learning disabilities, English as their second language or the elderly who live alone may find the application of the intervention difficult. However, it was noted that in some centres, people may be invited to the centres a day before surgery to assist in washing. Chlorohexidine wipes are also available however these are more expensive so their use is subject to funding with some NHS trusts being unable to fund their use.</p></div></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="ch1.appa"><h3>Appendix A. Review protocols</h3><div id="ch1.appa.s1"><h4>Review protocol for the effectiveness of nasal decolonisation in the prevention of surgical site infection</h4><p id="ch1.appa.fm1"><a href="/books/NBK569834/bin/ch1-appa-fm1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (856K)</span></p></div></div><div id="ch1.appb"><h3>Appendix B. Methods</h3><div id="ch1.appb.s1"><h4>Priority screening</h4><p>The reviews undertaken for this guideline all made use of the priority screening functionality with the EPPI-reviewer systematic reviewing software. This uses a machine learning algorithm (specifically, an SGD classifier) to take information on features (1, 2 and 3 word blocks) in the titles and abstract of papers marked as being ‘includes’ or ‘excludes’ during the title and abstract screening process, and re-orders the remaining records from most likely to least likely to be an include, based on that algorithm. This re-ordering of the remaining records occurs every time 25 additional records have been screened.</p><p>As an additional check to ensure this approach did not miss relevant studies, the included studies lists of included systematic reviews were searched to identify any papers not identified through the primary search.</p><div id="ch1.appb.s1.1"><h5>Quality assessment</h5><p>Individual systematic reviews were quality assessed using the ROBIS tool, with each classified into one of the following three groups:
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<ul id="ch1.l79"><li id="ch1.lt258" class="half_rhythm"><div>High quality – It is unlikely that additional relevant and important data would be identified from primary studies compared to that reported in the review, and unlikely that any relevant and important studies have been missed by the review.</div></li><li id="ch1.lt259" class="half_rhythm"><div>Moderate quality – It is possible that additional relevant and important data would be identified from primary studies compared to that reported in the review, but unlikely that any relevant and important studies have been missed by the review.</div></li><li id="ch1.lt260" class="half_rhythm"><div>Low quality – It is possible that relevant and important studies have been missed by the review.</div></li></ul></p><p>Each individual systematic review was also classified into one of three groups for its applicability as a source of data, based on how closely the review matches the specified review protocol in the guideline. Studies were rated as follows:
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<ul id="ch1.l80"><li id="ch1.lt261" class="half_rhythm"><div>Fully applicable – The identified review fully covers the review protocol in the guideline.</div></li><li id="ch1.lt262" class="half_rhythm"><div>Partially applicable – The identified review fully covers a discrete subsection of the review protocol in the guideline.</div></li><li id="ch1.lt263" class="half_rhythm"><div>Not applicable – The identified review, despite including studies relevant to the review question, does not fully cover any discrete subsection of the review protocol in the guideline.</div></li></ul></p></div><div id="ch1.appb.s1.2"><h5>Using systematic reviews as a source of data</h5><p>If systematic reviews were identified as being sufficiently applicable and high quality, and were identified sufficiently early in the review process (for example, from the surveillance review or early in the database search), they were used as the primary source of data, rather than extracting information from primary studies. The extent to which this was done depended on the quality and applicability of the review, as defined in <a class="figpopup" href="/books/NBK569834/table/ch1.appb.tab1/?report=objectonly" target="object" rid-figpopup="figch1appbtab1" rid-ob="figobch1appbtab1">Table 4</a>. When systematic reviews were used as a source of primary data, any unpublished or additional data included in the review which is not in the primary studies was also included. Data from these systematic reviews was then quality assessed and presented in GRADE tables as described below, in the same way as if data had been extracted from primary studies. In questions where data was extracted from both systematic reviews and primary studies, these were cross-referenced to ensure none of the data had been double counted through this process.</p><div id="ch1.appb.tab1" class="table"><h3><span class="label">Table 4</span><span class="title">Criteria for using systematic reviews as a source of data</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th><th id="hd_h_ch1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Applicability</th><th id="hd_h_ch1.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Use of systematic review</th></tr></thead><tbody><tr><td headers="hd_h_ch1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td><td headers="hd_h_ch1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fully applicable</td><td headers="hd_h_ch1.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data from the published systematic review were used instead of undertaking a new literature search or data analysis. Searches were only done to cover the period of time since the search date of the review.</td></tr><tr><td headers="hd_h_ch1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td><td headers="hd_h_ch1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable</td><td headers="hd_h_ch1.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data from the published systematic review were used instead of undertaking a new literature search and data analysis for the relevant subsection of the protocol. For this section, searches were only done to cover the period of time since the search date of the review. For other sections not covered by the systematic review, searches were undertaken as normal.</td></tr><tr><td headers="hd_h_ch1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td><td headers="hd_h_ch1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fully applicable</td><td headers="hd_h_ch1.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Details of included studies were used instead of undertaking a new literature search. Full-text papers of included studies were still retrieved for the purposes of data analysis. Searches were only done to cover the period of time since the search date of the review.</td></tr><tr><td headers="hd_h_ch1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td><td headers="hd_h_ch1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable</td><td headers="hd_h_ch1.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Details of included studies were used instead of undertaking a new literature search for the relevant subsection of the protocol. For this section, searches were only done to cover the period of time since the search date of the review. For other sections not covered by the systematic review, searches were undertaken as normal.</td></tr></tbody></table></div></div></div></div><div id="ch1.appb.s2"><h4>Evidence of effectiveness of interventions</h4><div id="ch1.appb.s2.1"><h5>Quality assessment</h5><p>Individual RCTs were quality assessed using the Cochrane Risk of Bias Tool. Other study were quality assessed using the ROBINS-I tool. Each individual study was classified into one of the following three groups:
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<ul id="ch1.l81"><li id="ch1.lt264" class="half_rhythm"><div>Low risk of bias – The true effect size for the study is likely to be close to the estimated effect size.</div></li><li id="ch1.lt265" class="half_rhythm"><div>Moderate risk of bias – There is a possibility the true effect size for the study is substantially different to the estimated effect size.</div></li><li id="ch1.lt266" class="half_rhythm"><div>High risk of bias – It is likely the true effect size for the study is substantially different to the estimated effect size.</div></li></ul></p><p>Each individual study was also classified into one of three groups for directness, based on if there were concerns about the population, intervention, comparator and/or outcomes in the study and how directly these variables could address the specified review question. Studies were rated as follows:
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<ul id="ch1.l82"><li id="ch1.lt267" class="half_rhythm"><div>Direct – No important deviations from the protocol in population, intervention, comparator and/or outcomes.</div></li><li id="ch1.lt268" class="half_rhythm"><div>Partially indirect – Important deviations from the protocol in one of the population, intervention, comparator and/or outcomes.</div></li><li id="ch1.lt269" class="half_rhythm"><div>Indirect – Important deviations from the protocol in at least two of the following areas: population, intervention, comparator and/or outcomes.</div></li></ul></p></div><div id="ch1.appb.s2.2"><h5>Methods for combining intervention evidence</h5><p>Meta-analyses of interventional data were conducted with reference to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins et al. 2011).</p><p>Where different studies presented continuous data measuring the same outcome but using different numerical scales (e.g. a 0–10 and a 0–100 visual analogue scale), these outcomes were all converted to the same scale before meta-analysis was conducted on the mean differences. Where outcomes measured the same underlying construct but used different instruments/metrics, data were analysed using standardised mean differences (Hedges’ g).</p><p>A pooled relative risk was calculated for dichotomous outcomes (using the Mantel–Haenszel method). Both relative and absolute risks were presented, with absolute risks calculated by applying the relative risk to the pooled risk in the comparator arm of the meta-analysis.</p><p>Fixed- and random-effects models (der Simonian and Laird) were fitted where appropriate, with the presented analysis dependent on the degree of heterogeneity in the assembled evidence. Fixed-effects models were the preferred choice to report, but in situations where the assumption of a shared mean for fixed-effects model were clearly not met, even after appropriate pre-specified subgroup analyses were conducted, random-effects results are presented. Fixed-effects models were deemed to be inappropriate if one or both of the following conditions was met:
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<ul id="ch1.l83"><li id="ch1.lt270" class="half_rhythm"><div>Significant between study heterogeneity in methodology, population, intervention or comparator was identified by the reviewer in advance of data analysis. This decision was made and recorded before any data analysis was undertaken.</div></li><li id="ch1.lt271" class="half_rhythm"><div>The presence of significant statistical heterogeneity in the meta-analysis, defined as I<sup>2</sup>≥50%.</div></li></ul></p><p>In any meta-analyses where some (but not all) of the data came from studies at high risk of bias, a sensitivity analysis was conducted, excluding those studies from the analysis. Results from both the full and restricted meta-analyses are reported. Similarly, in any meta-analyses where some (but not all) of the data came from indirect studies, a sensitivity analysis was conducted, excluding those studies from the analysis.</p><p>Meta-analyses were performed in Cochrane Review Manager v5.3.</p></div><div id="ch1.appb.s2.3"><h5>Minimal clinically important differences (MIDs)</h5><p>The Core Outcome Measures in Effectiveness Trials (COMET) database was searched to identify published minimal clinically important difference thresholds relevant to this guideline. Identified MIDs were assessed to ensure they had been developed and validated in a methodologically rigorous way, and were applicable to the populations, interventions and outcomes specified in this guideline. In addition, the Guideline Committee were asked to prospectively specify any outcomes where they felt a consensus MID could be defined from their experience. In particular, any questions looking to evaluate non-inferiority (that one treatment is not meaningfully worse than another) required an MID to be defined to act as a non-inferiority margin.</p><p>No MIDs were identified. Therefore, a default MID interval for dichotomous outcomes of 0.8 to 1.25 was used.</p><p>When decisions were made in situations where MIDs were not available, the ‘Evidence to Recommendations’ section of that review should make explicit the committee’s view of the expected clinical importance and relevance of the findings. In particular, this includes consideration of whether the whole effect of a treatment (which may be felt across multiple independent outcome domains) would be likely to be clinically meaningful, rather than simply whether each individual sub outcome might be meaningful in isolation.</p></div><div id="ch1.appb.s2.4"><h5>GRADE for pairwise meta-analyses of interventional evidence</h5><p>GRADE was used to assess the quality of evidence for the selected outcomes as specified in ‘Developing NICE guidelines: the manual (2014)’. Data from all study designs was initially rated as high quality and the quality of the evidence for each outcome was downgraded or not from this initial point, based on the criteria given in <a class="figpopup" href="/books/NBK569834/table/ch1.appb.tab2/?report=objectonly" target="object" rid-figpopup="figch1appbtab2" rid-ob="figobch1appbtab2">Table 5</a>.</p><div id="ch1.appb.tab2" class="table"><h3><span class="label">Table 5</span><span class="title">Rationale for downgrading quality of evidence for intervention studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appb.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GRADE criteria</th><th id="hd_h_ch1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reasons for downgrading quality</th></tr></thead><tbody><tr><td headers="hd_h_ch1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</td><td headers="hd_h_ch1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Not serious: If less than 33.3% of the weight in a meta-analysis came from studies at moderate or high risk of bias, the overall outcome was not downgraded.</p>
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<p>Serious: If greater than 33.3% of the weight in a meta-analysis came from studies at moderate or high risk of bias, the outcome was downgraded one level.</p>
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<p>Very serious: If greater than 33.3% of the weight in a meta-analysis came from studies at high risk of bias, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between studies at high and low risk of bias.</p>
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</td></tr><tr><td headers="hd_h_ch1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</td><td headers="hd_h_ch1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Not serious: If less than 33.3% of the weight in a meta-analysis came from partially indirect or indirect studies, the overall outcome was not downgraded.</p>
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<p>Serious: If greater than 33.3% of the weight in a meta-analysis came from partially indirect or indirect studies, the outcome was downgraded one level.</p>
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<p>Very serious: If greater than 33.3% of the weight in a meta-analysis came from indirect studies, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between direct and indirect studies.</p>
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</td></tr><tr><td headers="hd_h_ch1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</td><td headers="hd_h_ch1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Concerns about inconsistency of effects across studies, occurring when there is unexplained variability in the treatment effect demonstrated across studies (heterogeneity), after appropriate pre-specified subgroup analyses have been conducted. This was assessed using the I<sup>2</sup> statistic.</p>
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<p>N/A: Inconsistency was marked as not applicable if data on the outcome was only available from one study.</p>
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<p>Not serious: If the I<sup>2</sup> was less than 33.3%, the outcome was not downgraded.</p>
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<p>Serious: If the I<sup>2</sup> was between 33.3% and 66.7%, the outcome was downgraded one level.</p>
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<p>Very serious: If the I<sup>2</sup> was greater than 66.7%, the outcome was downgraded two levels.</p>
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<p>Outcomes meeting the criteria for downgrading above were not downgraded if there was evidence the effect size was not meaningfully different between studies with the smallest and largest effect sizes.</p>
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</td></tr><tr><td headers="hd_h_ch1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</td><td headers="hd_h_ch1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>If an MID other than the line of no effect was defined for the outcome, the outcome was downgraded once if the 95% confidence interval for the effect size crossed one line of the MID, and twice if it crosses both lines of the MID.</p>
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<p>If the line of no effect was defined as an MID for the outcome, it was downgraded once if the 95% confidence interval for the effect size crossed the line of no effect (i.e. the outcome was not statistically significant), and twice if the sample size of the study was sufficiently small that it is not plausible any realistic effect size could have been detected.</p>
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<p>For continuous outcomes, study was downgraded 1 level for non-significant results. Outcomes meeting the criteria for downgrading above were not downgraded if the confidence interval was sufficiently narrow that the upper and lower bounds would correspond to clinically equivalent scenarios.</p>
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</td></tr></tbody></table></div></div><p>The quality of evidence for each outcome was upgraded if any of the following three conditions were met:
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<ul id="ch1.l84"><li id="ch1.lt272" class="half_rhythm"><div>Data from non-randomised studies showing an effect size sufficiently large that it cannot be explained by confounding alone.</div></li><li id="ch1.lt273" class="half_rhythm"><div>Data showing a dose-response gradient.</div></li><li id="ch1.lt274" class="half_rhythm"><div>Data where all plausible residual confounding is likely to increase our confidence in the effect estimate.</div></li></ul></p></div><div id="ch1.appb.s2.5"><h5>Publication bias</h5><p>Publication bias was assessed in two ways. First, if evidence of conducted but unpublished studies was identified during the review (e.g. conference abstracts, trial protocols or trial records without accompanying published data), available information on these unpublished studies was reported as part of the review. Secondly, where 10 or more studies were included as part of a single meta-analysis, a funnel plot was produced to graphically assess the potential for publication bias.</p></div><div id="ch1.appb.s2.6"><h5>Evidence statements</h5><p>Evidence statements for pairwise intervention data are classified in to one of four categories:
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<ul id="ch1.l85"><li id="ch1.lt275" class="half_rhythm"><div>Situations where the data are only consistent, at a 95% confidence level, with an effect in one direction (i.e. one that is ‘statistically significant’), and the magnitude of that effect is most likely to meet or exceed the MID (i.e. the point estimate is not in the zone of equivalence). In such cases, we state that the evidence showed that there is an effect.</div></li><li id="ch1.lt276" class="half_rhythm"><div>Situations where the data are only consistent, at a 95% confidence level, with an effect in one direction (i.e. one that is ‘statistically significant’), but the magnitude of that effect is most likely to be less than the MID (i.e. the point estimate is in the zone of equivalence). In such cases, we state that the evidence could not demonstrate a meaningful difference.</div></li><li id="ch1.lt277" class="half_rhythm"><div>Situations where the data are consistent, at a 95% confidence level, with an effect in either direction (i.e. one that is not ‘statistically significant’) but the confidence limits are smaller than the MIDs in both directions. In such cases, we state that the evidence demonstrates that there is no difference.</div></li><li id="ch1.lt278" class="half_rhythm"><div>In all other cases, we state that the evidence could not differentiate between the comparators.</div></li></ul></p><p>For outcomes without a defined MID or where the MID is set as the line of no effect, evidence statements are divided into 2 groups as follows:
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<ul id="ch1.l86"><li id="ch1.lt279" class="half_rhythm"><div>We state that the evidence showed that there is an effect if the 95% CI does not cross the line of no effect.</div></li><li id="ch1.lt280" class="half_rhythm"><div>The evidence could not differentiate between comparators if the 95% CI crosses the line of no effect.</div></li></ul></p></div></div><div id="ch1.appb.s3"><h4>Health economics</h4><p>Literature reviews seeking to identify published cost–utility analyses of relevance to the issues under consideration were conducted for all questions. In each case, the search undertaken for the clinical review was modified, retaining population and intervention descriptors, but removing any study-design filter and adding a filter designed to identify relevant health economic analyses. In assessing studies for inclusion, population, intervention and comparator, criteria were always identical to those used in the parallel clinical search; only cost–utility analyses were included. Economic evidence profiles, including critical appraisal according to the Guidelines manual, were completed for included studies.</p><p>Economic studies identified through a systematic search of the literature are appraised using a methodology checklist designed for economic evaluations (NICE guidelines manual; 2014). This checklist is not intended to judge the quality of a study per se, but to determine whether an existing economic evaluation is useful to inform the decision-making of the committee for a specific topic within the guideline.</p><p>There are 2 parts of the appraisal process. The first step is to assess applicability (that is, the relevance of the study to the specific guideline topic and the NICE reference case); evaluations are categorised according to the criteria in <a class="figpopup" href="/books/NBK569834/table/ch1.appb.tab3/?report=objectonly" target="object" rid-figpopup="figch1appbtab3" rid-ob="figobch1appbtab3">Table 1</a>.</p><div id="ch1.appb.tab3" class="table"><h3><span class="label">Table 1</span><span class="title">Applicability criteria</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appb.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Level</th><th id="hd_h_ch1.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Explanation</th></tr></thead><tbody><tr><td headers="hd_h_ch1.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directly applicable</td><td headers="hd_h_ch1.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The study meets all applicability criteria, or fails to meet one or more applicability criteria but this is unlikely to change the conclusions about cost effectiveness</td></tr><tr><td headers="hd_h_ch1.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable</td><td headers="hd_h_ch1.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The study fails to meet one or more applicability criteria, and this could change the conclusions about cost effectiveness</td></tr><tr><td headers="hd_h_ch1.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td><td headers="hd_h_ch1.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The study fails to meet one or more applicability criteria, and this is likely to change the conclusions about cost effectiveness. These studies are excluded from further consideration</td></tr></tbody></table></div></div><p>In the second step, only those studies deemed directly or partially applicable are further assessed for limitations (that is, methodological quality); see categorisation criteria in <a class="figpopup" href="/books/NBK569834/table/ch1.appb.tab4/?report=objectonly" target="object" rid-figpopup="figch1appbtab4" rid-ob="figobch1appbtab4">Table 2</a>.</p><div id="ch1.appb.tab4" class="table"><h3><span class="label">Table 2</span><span class="title">Methodological criteria</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appb.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Level</th><th id="hd_h_ch1.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Explanation</th></tr></thead><tbody><tr><td headers="hd_h_ch1.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor limitations</td><td headers="hd_h_ch1.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meets all quality criteria, or fails to meet one or more quality criteria but this is unlikely to change the conclusions about cost effectiveness</td></tr><tr><td headers="hd_h_ch1.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potentially serious limitations</td><td headers="hd_h_ch1.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fails to meet one or more quality criteria and this could change the conclusions about cost effectiveness</td></tr><tr><td headers="hd_h_ch1.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious limitations</td><td headers="hd_h_ch1.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fails to meet one or more quality criteria and this is highly likely to change the conclusions about cost effectiveness. Such studies should usually be excluded from further consideration</td></tr></tbody></table></div></div><p>Studies were prioritised for inclusion based on their relative applicability to the development of this guideline and the study limitations. For example, if a high quality, directly applicable UK analysis was available, then other less relevant studies may not have been included. Where selective exclusions were made on this basis, this is noted in the relevant section.</p><p>Where relevant, a summary of the main findings from the systematic search, review and appraisal of economic evidence is presented in an economic evidence profile alongside the clinical evidence.</p></div></div><div id="ch1.appc"><h3>Appendix C. Literature search strategies</h3><p>Sources searched to identify the clinical evidence:
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<div id="ch1.appc.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appc.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appc.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Databases</th><th id="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Date searched</th><th id="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Version/files</th></tr></thead><tbody><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://onlinelibrary.wiley.com/cochranelibrary/search/quick" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cochrane Central Register of Controlled Trials (CENTRAL)</a></td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Issue 2 of 12, February 2018</td></tr><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://onlinelibrary.wiley.com/cochranelibrary/search/quick" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cochrane Database of Systematic Reviews (CDSR)</a></td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Issue 3 of 12, March 2018</td></tr><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://onlinelibrary.wiley.com/cochranelibrary/search/quick" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Database of Abstracts of Reviews of Effect (DARE)</a></td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Issue 2 of 4, April 2015</td></tr><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://ovidsp.uk.ovid.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Embase (Ovid)</a></td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 to 2018 March 14</td></tr><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://ovidsp.uk.ovid.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">MEDLINE (Ovid)</a></td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 to Present with Daily Update</td></tr><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://ovidsp.uk.ovid.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">MEDLINE In-Process (Ovid)</a></td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 to 2018 March 14</td></tr><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CINAHL with full text (EBSCO)</td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://ovidsp.uk.ovid.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PubMed</a></td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr><tr><td headers="hd_h_ch1.appc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MHRA</td><td headers="hd_h_ch1.appc.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td><td headers="hd_h_ch1.appc.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr></tbody></table></div></div></p><p>The MEDLINE search strategy is presented below. This was translated for use in all of the other databases listed. The aim of the search was to identify evidence for the clinical question being asked. Randomised Controlled Trial and Systematic Review filters were used to identify the study designs specified in the Review Protocol.</p><ol id="ch1.l87"><li id="ch1.lt281" class="half_rhythm"><div>Surgical Wound Infection/</div></li><li id="ch1.lt282" class="half_rhythm"><div>Wound Infection/</div></li><li id="ch1.lt283" class="half_rhythm"><div>SURGICAL WOUND DEHISCENCE/</div></li><li id="ch1.lt284" class="half_rhythm"><div>((wound? or incision* or suture*) adj4 (infect* or sepsis or septic* or dehiscen* or site* or contaminat* or disrupt* or ruptur* or separat*)).tw.</div></li><li id="ch1.lt285" class="half_rhythm"><div>(SSI or SSIs or SSTI or SSTIs).tw.</div></li><li id="ch1.lt286" class="half_rhythm"><div>or/1–5</div></li><li id="ch1.lt287" class="half_rhythm"><div>exp Specialties, Surgical/</div></li><li id="ch1.lt288" class="half_rhythm"><div>exp Surgical Procedures, Operative/</div></li><li id="ch1.lt289" class="half_rhythm"><div>surgery.fs.</div></li><li id="ch1.lt290" class="half_rhythm"><div>(surger* or surgical* or operat* or procedure* or postop* or post-op* or post op* or postsurg* or post-surg* or post surg* or presurg* or pre-surg* or pre surg* or preop* or pre-op* or pre op*).tw.</div></li><li id="ch1.lt291" class="half_rhythm"><div>exp Minimally Invasive Surgical Procedures/</div></li><li id="ch1.lt292" class="half_rhythm"><div>(arthroscop* or laparoscop* or thoracoscop* or endoscop*).tw.</div></li><li id="ch1.lt293" class="half_rhythm"><div>Infection Control/</div></li><li id="ch1.lt294" class="half_rhythm"><div>(infection adj4 control).tw.</div></li><li id="ch1.lt295" class="half_rhythm"><div>Postoperative Complications/</div></li><li id="ch1.lt296" class="half_rhythm"><div>Preoperative care/</div></li><li id="ch1.lt297" class="half_rhythm"><div>or/7–16</div></li><li id="ch1.lt298" class="half_rhythm"><div>Staphylococcal Infections/</div></li><li id="ch1.lt299" class="half_rhythm"><div>exp Staphylococcus aureus/</div></li><li id="ch1.lt300" class="half_rhythm"><div>(staph* adj4 aureus).tw.</div></li><li id="ch1.lt301" class="half_rhythm"><div>(MRSA or MSSA).tw.</div></li><li id="ch1.lt302" class="half_rhythm"><div>(methicillin adj4 resistant adj4 staph*).tw.</div></li><li id="ch1.lt303" class="half_rhythm"><div>“s aureus”.tw.</div></li><li id="ch1.lt304" class="half_rhythm"><div>Gram-positive Bacterial Infections/</div></li><li id="ch1.lt305" class="half_rhythm"><div>((gram-positive adj4 bacterial adj4 infection*) or (gram adj4 positive adj4 bacterial adj4 infection*)).tw.</div></li><li id="ch1.lt306" class="half_rhythm"><div>Cross Infection/</div></li><li id="ch1.lt307" class="half_rhythm"><div>(cross adj4 infection*).tw.</div></li><li id="ch1.lt308" class="half_rhythm"><div>((health adj4 care adj4 associated adj4 infection*) or (healthcare adj4 associated adj4 infection*)).tw.</div></li><li id="ch1.lt309" class="half_rhythm"><div>(hospital adj4 infection*).tw.</div></li><li id="ch1.lt310" class="half_rhythm"><div>nosocomial*.tw.</div></li><li id="ch1.lt311" class="half_rhythm"><div>exp Sepsis/</div></li><li id="ch1.lt312" class="half_rhythm"><div>(blood adj4 poisoning*).tw.</div></li><li id="ch1.lt313" class="half_rhythm"><div>(sepsis or septic* or pyaemi* or pyohemi*).tw.</div></li><li id="ch1.lt314" class="half_rhythm"><div>or/18–33</div></li><li id="ch1.lt315" class="half_rhythm"><div>17 and 34</div></li><li id="ch1.lt316" class="half_rhythm"><div>6 or 35</div></li><li id="ch1.lt317" class="half_rhythm"><div>exp Anti-Infective Agents, Local/</div></li><li id="ch1.lt318" class="half_rhythm"><div>Chlorhexidine/</div></li><li id="ch1.lt319" class="half_rhythm"><div>chlorhexidine.tw.</div></li><li id="ch1.lt320" class="half_rhythm"><div>(naseptin or novalsan or tubulicid or “sebidan a” or mk 412a or mk-412a or mk412a).tw. (44)</div></li><li id="ch1.lt321" class="half_rhythm"><div>(acriflex or bacticlens or bactigras or “cx powder” or cepton or chlorasept or chlorohex or clorhexitulle or corsodyl or curasept or dispray or eczmol or elgydium or hibidil or hibiscrub or hibitane or hydrex or periochip or perioguard or rotersept or savlon or serotulle or spotoway or sterexidine or steripod or gluconate or uniscrub or unisept or “uriflex c” or phiso-med or CB12 or cetriclens or chloraprep or Clearasil or covonia or cyteal or dermol or eludril or germolene or germoloid* or hibi or hibicet or hibisol or instillagel or medi-swab or medi-wipe or mycil or nystaform* or quinoderm or savloclens or savlodil or sterets or steriwipe or tisept or torbetol or travasept or tri-ac or xylocaine).tw.</div></li><li id="ch1.lt322" class="half_rhythm"><div>Mupirocin/</div></li><li id="ch1.lt323" class="half_rhythm"><div>(mupirocin* or bactroban).tw.</div></li><li id="ch1.lt324" class="half_rhythm"><div>Povidone-Iodine/</div></li><li id="ch1.lt325" class="half_rhythm"><div>((povidone adj4 iodine) or povidone-iodine).tw.</div></li><li id="ch1.lt326" class="half_rhythm"><div>((povidine adj4 iodine) or povidine-iodine).tw.</div></li><li id="ch1.lt327" class="half_rhythm"><div>(PVP-I or PVPI or PVP I or PVP-iodine or PVPiodine or pvp iodine or polyvinylpyrrolidoneiodine* or polyvinylpyrrolidone-iodine* or polyvinylpyrrolidone iodine*).tw.</div></li><li id="ch1.lt328" class="half_rhythm"><div>(alphadine* or betadine* or betaisodona or betasept or “brush off” or “cold sore lotion” or disadine* or inadine or pharmadine* or povidine* or “savlon dry” or videne or codella).tw. (530)</div></li><li id="ch1.lt329" class="half_rhythm"><div>(octenisan or octenide or octenidine or octeniderm or “win 41464” or “win 41464 2”).tw. (168)</div></li><li id="ch1.lt330" class="half_rhythm"><div>Decontamination/</div></li><li id="ch1.lt331" class="half_rhythm"><div>decontaminat*.tw.</div></li><li id="ch1.lt332" class="half_rhythm"><div>decoloni*.tw.</div></li><li id="ch1.lt333" class="half_rhythm"><div>or/37–52</div></li><li id="ch1.lt334" class="half_rhythm"><div>36 and 53</div></li><li id="ch1.lt335" class="half_rhythm"><div>exp glycopeptides/</div></li><li id="ch1.lt336" class="half_rhythm"><div>(glycopeptide* or glucopeptide* or macroglycopeptide* or bleomycin* or peptidoglycan* or ristocetin* or teicoplanin* or vancomycin*).tw.</div></li><li id="ch1.lt337" class="half_rhythm"><div>55 or 56</div></li><li id="ch1.lt338" class="half_rhythm"><div>exp Antibiotic Prophylaxis/</div></li><li id="ch1.lt339" class="half_rhythm"><div>(antibiotic adj4 (prophyla* or premedicat*)).tw.</div></li><li id="ch1.lt340" class="half_rhythm"><div>58 or 59</div></li><li id="ch1.lt341" class="half_rhythm"><div>36 and 57 and 60</div></li><li id="ch1.lt342" class="half_rhythm"><div>54 or 61</div></li><li id="ch1.lt343" class="half_rhythm"><div>Nasal Cavity/</div></li><li id="ch1.lt344" class="half_rhythm"><div>Nasal Mucosa/</div></li><li id="ch1.lt345" class="half_rhythm"><div>Nasopharynx/</div></li><li id="ch1.lt346" class="half_rhythm"><div>exp Oropharynx/</div></li><li id="ch1.lt347" class="half_rhythm"><div>nares.tw.</div></li><li id="ch1.lt348" class="half_rhythm"><div>nasal.tw.</div></li><li id="ch1.lt349" class="half_rhythm"><div>(nose or noses).tw.</div></li><li id="ch1.lt350" class="half_rhythm"><div>oropharyn*.tw.</div></li><li id="ch1.lt351" class="half_rhythm"><div>nasopharyn*.tw. (28630)</div></li><li id="ch1.lt352" class="half_rhythm"><div>pharyn*.tw. (34295)</div></li><li id="ch1.lt353" class="half_rhythm"><div>mouth.tw. (54514)</div></li><li id="ch1.lt354" class="half_rhythm"><div>Mouth/ (19975)</div></li><li id="ch1.lt355" class="half_rhythm"><div>(oral or orally).tw.</div></li><li id="ch1.lt356" class="half_rhythm"><div>Mouthwashes/</div></li><li id="ch1.lt357" class="half_rhythm"><div>(mouthwash* or mouthrins*).tw.</div></li><li id="ch1.lt358" class="half_rhythm"><div>Administration, Intranasal/</div></li><li id="ch1.lt359" class="half_rhythm"><div>(intranasal* or intra nasal* or intra-nasal*).tw.</div></li><li id="ch1.lt360" class="half_rhythm"><div>or/63–79</div></li><li id="ch1.lt361" class="half_rhythm"><div>62 and 80</div></li><li id="ch1.lt362" class="half_rhythm"><div>animals/ not humans/</div></li><li id="ch1.lt363" class="half_rhythm"><div>81 not 82</div></li><li id="ch1.lt364" class="half_rhythm"><div>limit 83 to i English language</div></li><li id="ch1.lt365" class="half_rhythm"><div>Randomized Controlled Trial.pt.</div></li><li id="ch1.lt366" class="half_rhythm"><div>Controlled Clinical Trial.pt.</div></li><li id="ch1.lt367" class="half_rhythm"><div>Clinical Trial.pt.</div></li><li id="ch1.lt368" class="half_rhythm"><div>exp Clinical Trials as Topic/</div></li><li id="ch1.lt369" class="half_rhythm"><div>Placebos/</div></li><li id="ch1.lt370" class="half_rhythm"><div>Random Allocation/</div></li><li id="ch1.lt371" class="half_rhythm"><div>Double-Blind Method/</div></li><li id="ch1.lt372" class="half_rhythm"><div>Single-Blind Method/</div></li><li id="ch1.lt373" class="half_rhythm"><div>Cross-Over Studies/</div></li><li id="ch1.lt374" class="half_rhythm"><div>((random$ or control$ or clinical$) adj3 (trial$ or stud$)).tw.</div></li><li id="ch1.lt375" class="half_rhythm"><div>(random$ adj3 allocat$).tw.</div></li><li id="ch1.lt376" class="half_rhythm"><div>placebo$.tw.</div></li><li id="ch1.lt377" class="half_rhythm"><div>((singl$ or doubl$ or trebl$ or tripl$) adj (blind$ or mask$)).tw.</div></li><li id="ch1.lt378" class="half_rhythm"><div>(crossover$ or (cross adj over$)).tw.</div></li><li id="ch1.lt379" class="half_rhythm"><div>or/85–98</div></li><li id="ch1.lt380" class="half_rhythm"><div>Meta-Analysis.pt.</div></li><li id="ch1.lt381" class="half_rhythm"><div>Network Meta-Analysis/</div></li><li id="ch1.lt382" class="half_rhythm"><div>Meta-Analysis as Topic/</div></li><li id="ch1.lt383" class="half_rhythm"><div>Review.pt.</div></li><li id="ch1.lt384" class="half_rhythm"><div>exp Review Literature as Topic/</div></li><li id="ch1.lt385" class="half_rhythm"><div>(metaanaly$ or metanaly$ or (meta adj3 analy$)).tw.</div></li><li id="ch1.lt386" class="half_rhythm"><div>(review$ or overview$).ti.</div></li><li id="ch1.lt387" class="half_rhythm"><div>(systematic$ adj5 (review$ or overview$)).tw.</div></li><li id="ch1.lt388" class="half_rhythm"><div>((quantitative$ or qualitative$) adj5 (review$ or overview$)).tw.</div></li><li id="ch1.lt389" class="half_rhythm"><div>((studies or trial$) adj2 (review$ or overview$)).tw.</div></li><li id="ch1.lt390" class="half_rhythm"><div>(integrat$ adj3 (research or review$ or literature)).tw.</div></li><li id="ch1.lt391" class="half_rhythm"><div>(pool$ adj2 (analy$ or data)).tw.</div></li><li id="ch1.lt392" class="half_rhythm"><div>(handsearch$ or (hand adj3 search$)).tw.</div></li><li id="ch1.lt393" class="half_rhythm"><div>(manual$ adj3 search$).tw.</div></li><li id="ch1.lt394" class="half_rhythm"><div>or/100–113</div></li><li id="ch1.lt395" class="half_rhythm"><div>99 or 114</div></li><li id="ch1.lt396" class="half_rhythm"><div>84 and 115</div></li></ol><div id="ch1.appc.s1"><h4>Economic evaluations and quality of life data</h4><p>Search filters to retrieve economic evaluations and quality of life papers were appended to the strategy listed above to identify relevant evidence. The MEDLINE economic evaluations and quality of life search filters are presented below. They were translated for use in MEDLINE in Process, Embase, The Cochrane Library, CINAHL and Econlit databases.</p><p>Sources searched to identify economic evaluations:
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<div id="ch1.appc.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appc.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appc.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Databases</th><th id="hd_h_ch1.appc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Date searched</th></tr></thead><tbody><tr><td headers="hd_h_ch1.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://ovidsp.uk.ovid.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Embase (Ovid)</a></td><td headers="hd_h_ch1.appc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td></tr><tr><td headers="hd_h_ch1.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://ovidsp.uk.ovid.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">MEDLINE (Ovid)</a></td><td headers="hd_h_ch1.appc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td></tr><tr><td headers="hd_h_ch1.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://ovidsp.uk.ovid.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">MEDLINE In-Process (Ovid)</a></td><td headers="hd_h_ch1.appc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td></tr><tr><td headers="hd_h_ch1.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://ovidsp.uk.ovid.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">EconLit (Ovid)</a></td><td headers="hd_h_ch1.appc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td></tr><tr><td headers="hd_h_ch1.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://onlinelibrary.wiley.com/cochranelibrary/search/quick" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NHS Economic Evaluation Database (NHS EED) (legacy database)</a></td><td headers="hd_h_ch1.appc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td></tr><tr><td headers="hd_h_ch1.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="http://onlinelibrary.wiley.com/cochranelibrary/search/quick" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Health Technology Assessment (HTA Database)</a></td><td headers="hd_h_ch1.appc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15/03/2018</td></tr><tr><td headers="hd_h_ch1.appc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CINAHL Plus with Fulltext (EBSCO)</td><td headers="hd_h_ch1.appc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16/03/2018</td></tr></tbody></table></div></div></p><div id="ch1.appc.s1.1"><h5>Economic evaluations</h5><ol id="ch1.l88"><li id="ch1.lt397" class="half_rhythm"><div>Economics/</div></li><li id="ch1.lt398" class="half_rhythm"><div>exp “Costs and Cost Analysis”/</div></li><li id="ch1.lt399" class="half_rhythm"><div>Economics, Dental/</div></li><li id="ch1.lt400" class="half_rhythm"><div>exp Economics, Hospital/</div></li><li id="ch1.lt401" class="half_rhythm"><div>exp Economics, Medical/</div></li><li id="ch1.lt402" class="half_rhythm"><div>Economics, Nursing/</div></li><li id="ch1.lt403" class="half_rhythm"><div>Economics, Pharmaceutical/</div></li><li id="ch1.lt404" class="half_rhythm"><div>Budgets/</div></li><li id="ch1.lt405" class="half_rhythm"><div>exp Models, Economic/</div></li><li id="ch1.lt406" class="half_rhythm"><div>Markov Chains/</div></li><li id="ch1.lt407" class="half_rhythm"><div>Monte Carlo Method/</div></li><li id="ch1.lt408" class="half_rhythm"><div>Decision Trees/</div></li><li id="ch1.lt409" class="half_rhythm"><div>econom$.tw.</div></li><li id="ch1.lt410" class="half_rhythm"><div>cba.tw.</div></li><li id="ch1.lt411" class="half_rhythm"><div>cea.tw.</div></li><li id="ch1.lt412" class="half_rhythm"><div>cua.tw.</div></li><li id="ch1.lt413" class="half_rhythm"><div>markov$.tw.</div></li><li id="ch1.lt414" class="half_rhythm"><div>(monte adj carlo).tw.</div></li><li id="ch1.lt415" class="half_rhythm"><div>(decision adj3 (tree$ or analys$)).tw.</div></li><li id="ch1.lt416" class="half_rhythm"><div>(cost or costs or costing$ or costly or costed).tw.</div></li><li id="ch1.lt417" class="half_rhythm"><div>(price$ or pricing$).tw.</div></li><li id="ch1.lt418" class="half_rhythm"><div>budget$.tw.</div></li><li id="ch1.lt419" class="half_rhythm"><div>expenditure$.tw.</div></li><li id="ch1.lt420" class="half_rhythm"><div>(value adj3 (money or monetary)).tw.</div></li><li id="ch1.lt421" class="half_rhythm"><div>(pharmacoeconomic$ or (pharmaco adj economic$)).tw.</div></li><li id="ch1.lt422" class="half_rhythm"><div>or/1–25</div></li></ol></div><div id="ch1.appc.s1.2"><h5>Quality of Life</h5><ol id="ch1.l89"><li id="ch1.lt423" class="half_rhythm"><div>“Quality of Life”/</div></li><li id="ch1.lt424" class="half_rhythm"><div>quality of life.tw.</div></li><li id="ch1.lt425" class="half_rhythm"><div>“Value of Life”/</div></li><li id="ch1.lt426" class="half_rhythm"><div>Quality-Adjusted Life Years/</div></li><li id="ch1.lt427" class="half_rhythm"><div>quality adjusted life.tw.</div></li><li id="ch1.lt428" class="half_rhythm"><div>(qaly$ or qald$ or qale$ or qtime$).tw.</div></li><li id="ch1.lt429" class="half_rhythm"><div>disability adjusted life.tw.</div></li><li id="ch1.lt430" class="half_rhythm"><div>daly$.tw.</div></li><li id="ch1.lt431" class="half_rhythm"><div>Health Status Indicators/</div></li><li id="ch1.lt432" class="half_rhythm"><div>(sf36 or sf 36 or short form 36 or shortform 36 or sf thirtysix or sf thirty six or shortform thirtysix or shortform thirty six or short form thirtysix or short form thirty six).tw.</div></li><li id="ch1.lt433" class="half_rhythm"><div>(sf6 or sf 6 or short form 6 or shortform 6 or sf six or sfsix or shortform six or short form six).tw.</div></li><li id="ch1.lt434" class="half_rhythm"><div>(sf12 or sf 12 or short form 12 or shortform 12 or sf twelve or sftwelve or shortform twelve or short form twelve).tw.</div></li><li id="ch1.lt435" class="half_rhythm"><div>(sf16 or sf 16 or short form 16 or shortform 16 or sf sixteen or sfsixteen or shortform sixteen or short form sixteen).tw.</div></li><li id="ch1.lt436" class="half_rhythm"><div>(sf20 or sf 20 or short form 20 or shortform 20 or sf twenty or sftwenty or shortform twenty or short form twenty).tw.</div></li><li id="ch1.lt437" class="half_rhythm"><div>(euroqol or euro qol or eq5d or eq 5d).tw.</div></li><li id="ch1.lt438" class="half_rhythm"><div>(qol or hql or hqol or hrqol).tw.</div></li><li id="ch1.lt439" class="half_rhythm"><div>(hye or hyes).tw.</div></li><li id="ch1.lt440" class="half_rhythm"><div>health$ year$ equivalent$.tw.</div></li><li id="ch1.lt441" class="half_rhythm"><div>utilit$.tw.</div></li><li id="ch1.lt442" class="half_rhythm"><div>(hui or hui1 or hui2 or hui3).tw.</div></li><li id="ch1.lt443" class="half_rhythm"><div>disutili$.tw.</div></li><li id="ch1.lt444" class="half_rhythm"><div>rosser.tw.</div></li><li id="ch1.lt445" class="half_rhythm"><div>quality of wellbeing.tw.</div></li><li id="ch1.lt446" class="half_rhythm"><div>quality of well-being.tw.</div></li><li id="ch1.lt447" class="half_rhythm"><div>qwb.tw.</div></li><li id="ch1.lt448" class="half_rhythm"><div>willingness to pay.tw.</div></li><li id="ch1.lt449" class="half_rhythm"><div>standard gamble$.tw.</div></li><li id="ch1.lt450" class="half_rhythm"><div>time trade off.tw.</div></li><li id="ch1.lt451" class="half_rhythm"><div>time tradeoff.tw.</div></li><li id="ch1.lt452" class="half_rhythm"><div>tto.tw.</div></li><li id="ch1.lt453" class="half_rhythm"><div>or/1–30</div></li></ol></div></div></div><div id="ch1.appd"><h3>Appendix D. Clinical evidence study selection</h3><div id="ch1.appd.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appdf1&p=BOOKS&id=569834_ch1appdf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appdf1.jpg" alt="Image ch1appdf1" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="ch1.appe"><h3>Appendix E. Clinical evidence tables</h3><div id="ch1.appe.s1"><h4>E.1.
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<a class="bk_pop" href="#ch1.appl.ref1">Bode (2010)</a>
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</h4><p id="ch1.appe.et1"><a href="/books/NBK569834/bin/ch1-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (146K)</span></p></div><div id="ch1.appe.s2"><h4>E.2.
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<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer (2002)</a>
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</h4><p id="ch1.appe.et2"><a href="/books/NBK569834/bin/ch1-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (189K)</span></p></div><div id="ch1.appe.s3"><h4>E.3.
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<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka (2006)</a>
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</h4><p id="ch1.appe.et3"><a href="/books/NBK569834/bin/ch1-appe-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (146K)</span></p></div><div id="ch1.appe.s4"><h4>E.4.
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<a class="bk_pop" href="#ch1.appl.ref4">Perl (2002)</a>
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</h4><p id="ch1.appe.et4"><a href="/books/NBK569834/bin/ch1-appe-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (190K)</span></p></div><div id="ch1.appe.s5"><h4>E.5.
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<a class="bk_pop" href="#ch1.appl.ref5">Philips (2014)</a>
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</h4><p id="ch1.appe.et5"><a href="/books/NBK569834/bin/ch1-appe-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (186K)</span></p></div><div id="ch1.appe.s6"><h4>E.6.
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<a class="bk_pop" href="#ch1.appl.ref6">Segers (2006)</a>
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</h4><p id="ch1.appe.et6"><a href="/books/NBK569834/bin/ch1-appe-et6.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (150K)</span></p></div><div id="ch1.appe.s7"><h4>E.7.
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<a class="bk_pop" href="#ch1.appl.ref7">Sousa (2016)</a>
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</h4><p id="ch1.appe.et7"><a href="/books/NBK569834/bin/ch1-appe-et7.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (183K)</span></p></div><div id="ch1.appe.s8"><h4>E.8.
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<a class="bk_pop" href="#ch1.appl.ref8">Suzuki (2003)</a>
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</h4><p id="ch1.appe.et8"><a href="/books/NBK569834/bin/ch1-appe-et8.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (144K)</span></p></div><div id="ch1.appe.s9"><h4>E.9.
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<a class="bk_pop" href="#ch1.appl.ref9">Tai (2013)</a>
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</h4><p id="ch1.appe.et9"><a href="/books/NBK569834/bin/ch1-appe-et9.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (181K)</span></p></div></div><div id="ch1.appf"><h3>Appendix F. Forest plots</h3><div id="ch1.appf.s1"><h4>F.1. Mupirocin versus placebo</h4><div id="ch1.appf.s1.1"><h5>Outcomes in whole population</h5><div id="ch1.appf.s1.1.1"><h5>Overall SSI</h5><div id="ch1.appf.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff1&p=BOOKS&id=569834_ch1appff1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff1.jpg" alt="Image ch1appff1" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s1.1.2"><h5>Overall superficial SSI</h5><div id="ch1.appf.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff2&p=BOOKS&id=569834_ch1appff2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff2.jpg" alt="Image ch1appff2" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s1.1.3"><h5>Overall deep SSI</h5><div id="ch1.appf.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff3&p=BOOKS&id=569834_ch1appff3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff3.jpg" alt="Image ch1appff3" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s1.1.4"><h5>S. aureus SSI</h5><div id="ch1.appf.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff4&p=BOOKS&id=569834_ch1appff4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff4.jpg" alt="Image ch1appff4" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s1.1.5"><h5>Overall nosocomial infections</h5><div id="ch1.appf.fig5" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff5&p=BOOKS&id=569834_ch1appff5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff5.jpg" alt="Image ch1appff5" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s1.1.6"><h5>S. aureus nosocomial infections</h5><div id="ch1.appf.fig6" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff6&p=BOOKS&id=569834_ch1appff6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff6.jpg" alt="Image ch1appff6" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s1.1.7"><h5>Hospital readmission</h5><div id="ch1.appf.fig7" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff7&p=BOOKS&id=569834_ch1appff7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff7.jpg" alt="Image ch1appff7" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s1.1.8"><h5>Mean hospital stay</h5><div id="ch1.appf.fig8" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff8&p=BOOKS&id=569834_ch1appff8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff8.jpg" alt="Image ch1appff8" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div></div><div id="ch1.appf.s1.2"><h5>Outcomes in <i>S. aureus</i> Carriers</h5><div id="ch1.appf.s1.2.1"><h5>Overall SSI</h5><div id="ch1.appf.fig9" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff9&p=BOOKS&id=569834_ch1appff9.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff9.jpg" alt="Image ch1appff9" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="ch1.appf.s1.2.2"><h5>Overall superficial SSI</h5><div id="ch1.appf.fig10" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff10&p=BOOKS&id=569834_ch1appff10.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff10.jpg" alt="Image ch1appff10" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: Within 8 weeks</p></div></div></div><div id="ch1.appf.s1.2.3"><h5>Overall deep SSI</h5><div id="ch1.appf.fig11" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff11&p=BOOKS&id=569834_ch1appff11.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff11.jpg" alt="Image ch1appff11" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: Within 8 weeks</p></div></div></div><div id="ch1.appf.s1.2.4"><h5>Overall deep space occupying SSI</h5><div id="ch1.appf.fig12" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff12&p=BOOKS&id=569834_ch1appff12.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff12.jpg" alt="Image ch1appff12" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: Within 8 weeks</p></div></div></div><div id="ch1.appf.s1.2.5"><h5>S. aureus SSI</h5><div id="ch1.appf.fig13" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff13&p=BOOKS&id=569834_ch1appff13.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff13.jpg" alt="Image ch1appff13" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="ch1.appf.s1.2.6"><h5>Overall nosocomial infections</h5><div id="ch1.appf.fig14" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff14&p=BOOKS&id=569834_ch1appff14.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff14.jpg" alt="Image ch1appff14" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="ch1.appf.s1.2.7"><h5>S. aureus nosocomial infections</h5><div id="ch1.appf.fig15" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff15&p=BOOKS&id=569834_ch1appff15.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff15.jpg" alt="Image ch1appff15" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s1.2.8"><h5>Mortality</h5><div id="ch1.appf.fig16" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff16&p=BOOKS&id=569834_ch1appff16.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff16.jpg" alt="Image ch1appff16" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: Within 8 weeks</p></div></div></div></div></div><div id="ch1.appf.s2"><h4>F.2. Mupirocin versus no nasal decontamination</h4><div id="ch1.appf.s2.1"><h5>Outcomes in whole population</h5><div id="ch1.appf.s2.1.1"><h5>Overall SSI</h5><div id="ch1.appf.fig17" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff17&p=BOOKS&id=569834_ch1appff17.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff17.jpg" alt="Image ch1appff17" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s2.1.2"><h5>Overall superficial SSI</h5><div id="ch1.appf.fig18" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff18&p=BOOKS&id=569834_ch1appff18.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff18.jpg" alt="Image ch1appff18" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s2.1.3"><h5>Overall deep SSI</h5><div id="ch1.appf.fig19" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff19&p=BOOKS&id=569834_ch1appff19.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff19.jpg" alt="Image ch1appff19" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s2.1.4"><h5>S. aureus SSI</h5><div id="ch1.appf.fig20" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff20&p=BOOKS&id=569834_ch1appff20.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff20.jpg" alt="Image ch1appff20" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div><div id="ch1.appf.s2.1.5"><h5>Overall nosocomial infections</h5><div id="ch1.appf.fig21" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff21&p=BOOKS&id=569834_ch1appff21.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff21.jpg" alt="Image ch1appff21" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: 30 days</p></div></div></div></div></div><div id="ch1.appf.s3"><h4>F.3. Mupirocin versus 5% Povidone Iodine</h4><div id="ch1.appf.s3.1"><h5>Outcomes in whole population</h5><div id="ch1.appf.s3.1.1"><h5>Overall deep SSI</h5><div id="ch1.appf.fig22" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff22&p=BOOKS&id=569834_ch1appff22.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff22.jpg" alt="Image ch1appff22" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: within 3 months</p></div></div></div><div id="ch1.appf.s3.1.2"><h5>S. aureus deep SSI</h5><div id="ch1.appf.fig23" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff23&p=BOOKS&id=569834_ch1appff23.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff23.jpg" alt="Image ch1appff23" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: within 3 months</p></div></div></div><div id="ch1.appf.s3.1.3"><h5>MRSA deep SSI</h5><div id="ch1.appf.fig24" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff24&p=BOOKS&id=569834_ch1appff24.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff24.jpg" alt="Image ch1appff24" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: within 3 months</p></div></div></div><div id="ch1.appf.s3.1.4"><h5>MSSA deep SSI</h5><div id="ch1.appf.fig25" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff25&p=BOOKS&id=569834_ch1appff25.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff25.jpg" alt="Image ch1appff25" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: within 3 month</p></div></div></div></div></div><div id="ch1.appf.s4"><h4>F.4. Mupirocin + CH wash versus no treatment</h4><div id="ch1.appf.s4.1"><h5>S. aureus carriers</h5><div id="ch1.appf.s4.1.1"><h5>Overall deep SSI (PJI)</h5><div id="ch1.appf.fig26" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff26&p=BOOKS&id=569834_ch1appff26.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff26.jpg" alt="Image ch1appff26" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 1 year</p></div></div></div><div id="ch1.appf.s4.1.2"><h5>S. aureus deep SSI (PJI)</h5><div id="ch1.appf.fig27" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff27&p=BOOKS&id=569834_ch1appff27.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff27.jpg" alt="Image ch1appff27" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 1 year</p></div></div></div><div id="ch1.appf.s4.1.3"><h5>S. aureus SSI</h5><div id="ch1.appf.fig28" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff28&p=BOOKS&id=569834_ch1appff28.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff28.jpg" alt="Image ch1appff28" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: postoperative period</p></div></div></div><div id="ch1.appf.s4.1.4"><h5>MRSA SSI</h5><div id="ch1.appf.fig29" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff29&p=BOOKS&id=569834_ch1appff29.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff29.jpg" alt="Image ch1appff29" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: postoperative period</p></div></div></div><div id="ch1.appf.s4.1.5"><h5>MSSA SSI</h5><div id="ch1.appf.fig30" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff30&p=BOOKS&id=569834_ch1appff30.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff30.jpg" alt="Image ch1appff30" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: postoperative period</p></div></div></div></div></div><div id="ch1.appf.s5"><h4>F.5. Mupirocin + CH wash versus placebo</h4><div id="ch1.appf.s5.1"><h5>S. aureus carriers</h5><div id="ch1.appf.s5.1.1"><h5>S. aureus SSI</h5><div id="ch1.appf.fig31" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff31&p=BOOKS&id=569834_ch1appff31.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff31.jpg" alt="Image ch1appff31" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: until 6 weeks after discharge</p></div></div></div><div id="ch1.appf.s5.1.2"><h5>S. aureus superficial SSI</h5><div id="ch1.appf.fig32" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff32&p=BOOKS&id=569834_ch1appff32.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff32.jpg" alt="Image ch1appff32" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: until 6 weeks after discharge</p></div></div></div><div id="ch1.appf.s5.1.3"><h5>S. aureus deep SSI</h5><div id="ch1.appf.fig33" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff33&p=BOOKS&id=569834_ch1appff33.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff33.jpg" alt="Image ch1appff33" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: until 6 weeks after discharge</p></div></div></div><div id="ch1.appf.s5.1.4"><h5>S. aureus nosocomial infections</h5><div id="ch1.appf.fig34" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff34&p=BOOKS&id=569834_ch1appff34.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff34.jpg" alt="Image ch1appff34" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: until 6 weeks after discharge</p></div></div></div><div id="ch1.appf.s5.1.5"><h5>Mortality</h5><div id="ch1.appf.fig35" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff35&p=BOOKS&id=569834_ch1appff35.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff35.jpg" alt="Image ch1appff35" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: until 6 weeks after discharge</p></div></div></div><div id="ch1.appf.s5.1.6"><h5>Mortality in carriers with S. aureus infections</h5><div id="ch1.appf.fig36" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff36&p=BOOKS&id=569834_ch1appff36.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff36.jpg" alt="Image ch1appff36" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: until 6 weeks after discharge</p></div></div></div></div></div><div id="ch1.appf.s6"><h4>F.6. Mupirocin (with or without CH was) versus all non-active interventions</h4><div id="ch1.appf.s6.1"><h5><i>S. aureus</i> carriers</h5><div id="ch1.appf.s6.1.1"><h5>S. aureus SSI</h5><div id="ch1.appf.fig37" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff37&p=BOOKS&id=569834_ch1appff37.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff37.jpg" alt="Image ch1appff37" class="tileshop" title="Click on image to zoom" /></a></div></div></div></div></div><div id="ch1.appf.s7"><h4>F.7. Chlorhexidine + CH wash versus placebo</h4><div id="ch1.appf.s7.1"><h5>Whole population</h5><div id="ch1.appf.s7.1.1"><h5>Overall SSI</h5><div id="ch1.appf.fig38" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff38&p=BOOKS&id=569834_ch1appff38.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff38.jpg" alt="Image ch1appff38" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div><div id="ch1.appf.s7.1.2"><h5>Overall deep SSI</h5><div id="ch1.appf.fig39" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff39&p=BOOKS&id=569834_ch1appff39.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff39.jpg" alt="Image ch1appff39" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div><div id="ch1.appf.s7.1.3"><h5>S. aureus SSI</h5><div id="ch1.appf.fig40" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff40&p=BOOKS&id=569834_ch1appff40.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff40.jpg" alt="Image ch1appff40" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div><div id="ch1.appf.s7.1.4"><h5>Overall nosocomial infection</h5><div id="ch1.appf.fig41" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff41&p=BOOKS&id=569834_ch1appff41.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff41.jpg" alt="Image ch1appff41" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div><div id="ch1.appf.s7.1.5"><h5>Nosocomial infection: Lower respiratory tract infection (LRTI)</h5><div id="ch1.appf.fig42" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff42&p=BOOKS&id=569834_ch1appff42.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff42.jpg" alt="Image ch1appff42" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div><div id="ch1.appf.s7.1.6"><h5>Nosocomial infection: urinary tract infection (UTI)</h5><div id="ch1.appf.fig43" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff43&p=BOOKS&id=569834_ch1appff43.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff43.jpg" alt="Image ch1appff43" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div><div id="ch1.appf.s7.1.7"><h5>Nosocomial infection: bacteraemia</h5><div id="ch1.appf.fig44" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff44&p=BOOKS&id=569834_ch1appff44.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff44.jpg" alt="Image ch1appff44" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div><div id="ch1.appf.s7.1.8"><h5>Mortality</h5><div id="ch1.appf.fig45" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff45&p=BOOKS&id=569834_ch1appff45.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff45.jpg" alt="Image ch1appff45" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 day</p></div></div></div><div id="ch1.appf.s7.1.9"><h5>Mean hospital stay</h5><div id="ch1.appf.fig46" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff46&p=BOOKS&id=569834_ch1appff46.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff46.jpg" alt="Image ch1appff46" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div><div id="ch1.appf.s7.1.10"><h5>Hospital readmission</h5><div id="ch1.appf.fig47" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appff47&p=BOOKS&id=569834_ch1appff47.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appff47.jpg" alt="Image ch1appff47" class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Follow up: at 30 days</p></div></div></div></div></div></div><div id="ch1.appg"><h3>Appendix G. GRADE tables</h3><div id="ch1.appg.s1"><h4>G.1. Mupirocin versus placebo</h4><div id="ch1.appg.s1.1"><h5>Outcomes in whole population</h5><div id="ch1.appg.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appg.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appg.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_ch1.appg.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_ch1.appg.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_ch1.appg.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_ch1.appg.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: control<sup><a class="bk_pop" href="#ch1.appg.tab1_7">*</a></sup></th><th id="hd_h_ch1.appg.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: intervention (95% CI)</th><th id="hd_h_ch1.appg.tab1_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_ch1.appg.tab1_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_ch1.appg.tab1_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_ch1.appg.tab1_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_ch1.appg.tab1_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_h_ch1.appg.tab1_1_1_1_2 hd_h_ch1.appg.tab1_1_1_1_3 hd_h_ch1.appg.tab1_1_1_1_4 hd_h_ch1.appg.tab1_1_1_1_5 hd_h_ch1.appg.tab1_1_1_1_6 hd_h_ch1.appg.tab1_1_1_1_7 hd_h_ch1.appg.tab1_1_1_1_8 hd_h_ch1.appg.tab1_1_1_1_9 hd_h_ch1.appg.tab1_1_1_1_10 hd_h_ch1.appg.tab1_1_1_1_11" id="hd_b_ch1.appg.tab1_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall SSI – RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>2</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
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</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
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</td><td headers="hd_h_ch1.appg.tab1_1_1_1_2 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab1_1_1_1_3 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4478</td><td headers="hd_h_ch1.appg.tab1_1_1_1_4 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.92 (95% CI 0.75, 1.12)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_5 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 per 100 people</td><td headers="hd_h_ch1.appg.tab1_1_1_1_6 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 per 100 people (6, 9)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_7 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_8 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_9 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_10 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_11 hd_b_ch1.appg.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_h_ch1.appg.tab1_1_1_1_2 hd_h_ch1.appg.tab1_1_1_1_3 hd_h_ch1.appg.tab1_1_1_1_4 hd_h_ch1.appg.tab1_1_1_1_5 hd_h_ch1.appg.tab1_1_1_1_6 hd_h_ch1.appg.tab1_1_1_1_7 hd_h_ch1.appg.tab1_1_1_1_8 hd_h_ch1.appg.tab1_1_1_1_9 hd_h_ch1.appg.tab1_1_1_1_10 hd_h_ch1.appg.tab1_1_1_1_11" id="hd_b_ch1.appg.tab1_1_1_3_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall superficial SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab1_1_1_1_2 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab1_1_1_1_3 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">614</td><td headers="hd_h_ch1.appg.tab1_1_1_1_4 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.88 (95% CI 0.41, 1.89)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_5 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab1_1_1_1_6 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people (6,8)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_7 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_8 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_9 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab1_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_10 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_11 hd_b_ch1.appg.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_h_ch1.appg.tab1_1_1_1_2 hd_h_ch1.appg.tab1_1_1_1_3 hd_h_ch1.appg.tab1_1_1_1_4 hd_h_ch1.appg.tab1_1_1_1_5 hd_h_ch1.appg.tab1_1_1_1_6 hd_h_ch1.appg.tab1_1_1_1_7 hd_h_ch1.appg.tab1_1_1_1_8 hd_h_ch1.appg.tab1_1_1_1_9 hd_h_ch1.appg.tab1_1_1_1_10 hd_h_ch1.appg.tab1_1_1_1_11" id="hd_b_ch1.appg.tab1_1_1_5_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall deep SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab1_1_1_1_2 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab1_1_1_1_3 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">614</td><td headers="hd_h_ch1.appg.tab1_1_1_1_4 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.32 (95% CI 0.01, 7.74)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_5 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people</td><td headers="hd_h_ch1.appg.tab1_1_1_1_6 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (0, 26)<sup><a class="bk_pop" href="#ch1.appg.tab1_8">**</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_7 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_8 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_9 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab1_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_10 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_11 hd_b_ch1.appg.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr><tr><th headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_h_ch1.appg.tab1_1_1_1_2 hd_h_ch1.appg.tab1_1_1_1_3 hd_h_ch1.appg.tab1_1_1_1_4 hd_h_ch1.appg.tab1_1_1_1_5 hd_h_ch1.appg.tab1_1_1_1_6 hd_h_ch1.appg.tab1_1_1_1_7 hd_h_ch1.appg.tab1_1_1_1_8 hd_h_ch1.appg.tab1_1_1_1_9 hd_h_ch1.appg.tab1_1_1_1_10 hd_h_ch1.appg.tab1_1_1_1_11" id="hd_b_ch1.appg.tab1_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>2</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
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</p>
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<p>
|
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<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
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</p>
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|
</td><td headers="hd_h_ch1.appg.tab1_1_1_1_2 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab1_1_1_1_3 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4400</td><td headers="hd_h_ch1.appg.tab1_1_1_1_4 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.88 (95% CI 0.60, 1.30)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_5 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people</td><td headers="hd_h_ch1.appg.tab1_1_1_1_6 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (2,19)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_7 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_8 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_9 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_10 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_11 hd_b_ch1.appg.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr><tr><th headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_h_ch1.appg.tab1_1_1_1_2 hd_h_ch1.appg.tab1_1_1_1_3 hd_h_ch1.appg.tab1_1_1_1_4 hd_h_ch1.appg.tab1_1_1_1_5 hd_h_ch1.appg.tab1_1_1_1_6 hd_h_ch1.appg.tab1_1_1_1_7 hd_h_ch1.appg.tab1_1_1_1_8 hd_h_ch1.appg.tab1_1_1_1_9 hd_h_ch1.appg.tab1_1_1_1_10 hd_h_ch1.appg.tab1_1_1_1_11" id="hd_b_ch1.appg.tab1_1_1_9_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall nosocomial infections (bloodstream, respiratory tract, catheter and surgical site) - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1</p>
|
|
<p>
|
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<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
|
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</p>
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|
</td><td headers="hd_h_ch1.appg.tab1_1_1_1_2 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab1_1_1_1_3 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3864</td><td headers="hd_h_ch1.appg.tab1_1_1_1_4 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.99 (95% CI 0.83, 1.18)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_5 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 100 people</td><td headers="hd_h_ch1.appg.tab1_1_1_1_6 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 100 people (9, 13)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_7 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_8 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_9 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab1_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_10 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_11 hd_b_ch1.appg.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_h_ch1.appg.tab1_1_1_1_2 hd_h_ch1.appg.tab1_1_1_1_3 hd_h_ch1.appg.tab1_1_1_1_4 hd_h_ch1.appg.tab1_1_1_1_5 hd_h_ch1.appg.tab1_1_1_1_6 hd_h_ch1.appg.tab1_1_1_1_7 hd_h_ch1.appg.tab1_1_1_1_8 hd_h_ch1.appg.tab1_1_1_1_9 hd_h_ch1.appg.tab1_1_1_1_10 hd_h_ch1.appg.tab1_1_1_1_11" id="hd_b_ch1.appg.tab1_1_1_11_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus nosocomial infections at 30 days (bloodstream, respiratory tract, catheter and surgical site) - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1</p>
|
|
<p>
|
|
<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
|
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</p>
|
|
</td><td headers="hd_h_ch1.appg.tab1_1_1_1_2 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab1_1_1_1_3 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3770</td><td headers="hd_h_ch1.appg.tab1_1_1_1_4 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.82 (95% CI 0.56, 1.21)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_5 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people</td><td headers="hd_h_ch1.appg.tab1_1_1_1_6 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (2,4)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_7 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_8 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_9 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab1_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_10 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_11 hd_b_ch1.appg.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_h_ch1.appg.tab1_1_1_1_2 hd_h_ch1.appg.tab1_1_1_1_3 hd_h_ch1.appg.tab1_1_1_1_4 hd_h_ch1.appg.tab1_1_1_1_5 hd_h_ch1.appg.tab1_1_1_1_6 hd_h_ch1.appg.tab1_1_1_1_7 hd_h_ch1.appg.tab1_1_1_1_8 hd_h_ch1.appg.tab1_1_1_1_9 hd_h_ch1.appg.tab1_1_1_1_10 hd_h_ch1.appg.tab1_1_1_1_11" id="hd_b_ch1.appg.tab1_1_1_13_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Hospital Readmission – RR< 1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1</p>
|
|
<p>
|
|
<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
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</p>
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|
</td><td headers="hd_h_ch1.appg.tab1_1_1_1_2 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab1_1_1_1_3 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">614</td><td headers="hd_h_ch1.appg.tab1_1_1_1_4 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.63 (95% CI 0.11, 3.76)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_5 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people</td><td headers="hd_h_ch1.appg.tab1_1_1_1_6 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people (0, 4)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_7 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_8 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_9 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab1_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_10 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_11 hd_b_ch1.appg.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_h_ch1.appg.tab1_1_1_1_2 hd_h_ch1.appg.tab1_1_1_1_3 hd_h_ch1.appg.tab1_1_1_1_4 hd_h_ch1.appg.tab1_1_1_1_5 hd_h_ch1.appg.tab1_1_1_1_6 hd_h_ch1.appg.tab1_1_1_1_7 hd_h_ch1.appg.tab1_1_1_1_8 hd_h_ch1.appg.tab1_1_1_1_9 hd_h_ch1.appg.tab1_1_1_1_10 hd_h_ch1.appg.tab1_1_1_1_11" id="hd_b_ch1.appg.tab1_1_1_15_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Mean hospital stay–effect size below 0 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab1_1_1_1_1 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab1_1_1_1_2 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab1_1_1_1_3 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">614</td><td headers="hd_h_ch1.appg.tab1_1_1_1_4 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD −0.30 (95% CI −1.38, 0.78)</td><td headers="hd_h_ch1.appg.tab1_1_1_1_5 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch1.appg.tab1_1_1_1_6 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch1.appg.tab1_1_1_1_7 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_8 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab1_1_1_1_9 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab1_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_10 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab1_6">6</a></sup></td><td headers="hd_h_ch1.appg.tab1_1_1_1_11 hd_b_ch1.appg.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="ch1.appg.tab1_1"><p class="no_margin">Greater than 33.3% of the weight in the meta-analysis came from a study at moderate risk of bias. Downgrade 1 level for serious risk of bias.</p></div></dd><dt>2</dt><dd><div id="ch1.appg.tab1_2"><p class="no_margin">95% confidence interval crosses one end of a defined MID interval (0.8, 1.25). Downgrade 1 level.</p></div></dd><dt>3</dt><dd><div id="ch1.appg.tab1_3"><p class="no_margin">Inconsistency not applicable</p></div></dd><dt>4</dt><dd><div id="ch1.appg.tab1_4"><p class="no_margin">95% confidence interval crosses both ends of a defined MID interval (0.8, 1.25). Downgrade 2 levels.</p></div></dd><dt>5</dt><dd><div id="ch1.appg.tab1_5"><p class="no_margin">Study demonstrated unclear random sequence generation, allocation concealment and blinding of outcome assessment. Downgrade 1 level for serious risk of bias.</p></div></dd><dt>6</dt><dd><div id="ch1.appg.tab1_6"><p class="no_margin">Non-significant result. Downgrade 1 level.</p></div></dd><dt>*</dt><dd><div id="ch1.appg.tab1_7"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 100</p></div></dd><dt>**</dt><dd><div id="ch1.appg.tab1_8"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 1000</p></div></dd></dl></div></div></div></div><div id="ch1.appg.s1.2"><h5>Outcomes in S. aureus carriers</h5><div id="ch1.appg.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appg.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appg.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_ch1.appg.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_ch1.appg.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_ch1.appg.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_ch1.appg.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: control<sup><a class="bk_pop" href="#ch1.appg.tab2_6">*</a></sup></th><th id="hd_h_ch1.appg.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: intervention (95% CI)</th><th id="hd_h_ch1.appg.tab2_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_ch1.appg.tab2_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_ch1.appg.tab2_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_ch1.appg.tab2_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_ch1.appg.tab2_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>2</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
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</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1148</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.08 (95% CI 0.59, 1.97)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 per 100 people (6, 22)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_3_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall SSI at 30 days - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">891</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.85 (95% CI 0.58, 1.24)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 per 100 people (7, 14)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_6">6</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_5_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall SSI within 8 weeks of surgery - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">257</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.60 (95% CI 0.79, 3.25)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 per 100 people (7, 28)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall superficial SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">257</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.85 (95% CI 0.85, 3.99)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 per 100 people (6, 28)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_6">6</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_9_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall deep SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">257</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.98 (95% CI 0.06, 15.45)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people (0, 12)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_11_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall deep space occupying SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">257</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.33 (95% CI 0.01, 7.92)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 100 people (0, 6)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_13_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>3</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
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</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
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</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
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</p>
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|
</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1318</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.66 (95% CI 0.40, 1.11)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (2, 6)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_6">6</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_15_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI at 30 days- RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>2</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
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</p>
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<p>
|
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<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
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</p>
|
|
</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1,061</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.59 (95% CI: 0.33, 1.04)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (2,6)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_6">6</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_17_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI within 8 weeks of surgery- RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1</p>
|
|
<p>
|
|
<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
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|
</p>
|
|
</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">257</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.22 (95% CI: 0.34, 4.44)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people (1,14)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_19_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall nosocomial infections (bloodstream, respiratory tract, catheter and surgical site) - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1</p>
|
|
<p>
|
|
<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
|
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">891</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.80 (95% CI 0.58, 1.10)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 per 100 people (9, 18)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_6">6</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_21_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus nosocomial infections (bloodstream, respiratory tract, catheter and surgical site) - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">869</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.51 (95% CI 0.29, 0.90)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people (2, 7)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_6">6</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_21_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_h_ch1.appg.tab2_1_1_1_2 hd_h_ch1.appg.tab2_1_1_1_3 hd_h_ch1.appg.tab2_1_1_1_4 hd_h_ch1.appg.tab2_1_1_1_5 hd_h_ch1.appg.tab2_1_1_1_6 hd_h_ch1.appg.tab2_1_1_1_7 hd_h_ch1.appg.tab2_1_1_1_8 hd_h_ch1.appg.tab2_1_1_1_9 hd_h_ch1.appg.tab2_1_1_1_10 hd_h_ch1.appg.tab2_1_1_1_11" id="hd_b_ch1.appg.tab2_1_1_23_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Mortality - RR< 1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab2_1_1_1_1 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab2_1_1_1_2 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab2_1_1_1_3 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">257</td><td headers="hd_h_ch1.appg.tab2_1_1_1_4 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.78 (95% CI 0.21, 2.84)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_5 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab2_1_1_1_6 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (1, 11)</td><td headers="hd_h_ch1.appg.tab2_1_1_1_7 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_8 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab2_1_1_1_9 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab2_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_10 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab2_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab2_1_1_1_11 hd_b_ch1.appg.tab2_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="ch1.appg.tab2_1"><p class="no_margin">Greater than 33.3% of the weight in the meta-analysis came from a study at moderate risk of bias. Downgrade 1 level for serious risk of bias.</p></div></dd><dt>2</dt><dd><div id="ch1.appg.tab2_2"><p class="no_margin">The I<sup>2</sup> was between 33.3% and 66.7%, the outcome was downgraded one level.</p></div></dd><dt>3</dt><dd><div id="ch1.appg.tab2_3"><p class="no_margin">95% confidence interval crosses both ends of a defined MID interval (0.8, 1.25). Downgrade 2 levels.</p></div></dd><dt>4</dt><dd><div id="ch1.appg.tab2_4"><p class="no_margin">Study demonstrated unclear random sequence generation, allocation concealment and blinding of outcome assessment. Downgrade 1 level for serious risk of bias.</p></div></dd><dt>5</dt><dd><div id="ch1.appg.tab2_5"><p class="no_margin">Inconsistency not applicable</p></div></dd><dt>6</dt><dd><div id="ch1.appg.tab2_6"><p class="no_margin">95% confidence interval crosses one end of a defined MID interval (0.8, 1.25). Downgrade 1 level.</p></div></dd><dt>*</dt><dd><div id="ch1.appg.tab2_7"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 100</p></div></dd></dl></div></div></div></div></div><div id="ch1.appg.s2"><h4>G.2. Mupirocin versus no nasal decontamination</h4><div id="ch1.appg.s2.1"><h5>Outcomes in whole population</h5><div id="ch1.appg.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appg.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appg.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_ch1.appg.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_ch1.appg.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_ch1.appg.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_ch1.appg.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: control<sup><a class="bk_pop" href="#ch1.appg.tab3_4">*</a></sup></th><th id="hd_h_ch1.appg.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: intervention (95% CI)</th><th id="hd_h_ch1.appg.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_ch1.appg.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_ch1.appg.tab3_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_ch1.appg.tab3_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_ch1.appg.tab3_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_h_ch1.appg.tab3_1_1_1_2 hd_h_ch1.appg.tab3_1_1_1_3 hd_h_ch1.appg.tab3_1_1_1_4 hd_h_ch1.appg.tab3_1_1_1_5 hd_h_ch1.appg.tab3_1_1_1_6 hd_h_ch1.appg.tab3_1_1_1_7 hd_h_ch1.appg.tab3_1_1_1_8 hd_h_ch1.appg.tab3_1_1_1_9 hd_h_ch1.appg.tab3_1_1_1_10 hd_h_ch1.appg.tab3_1_1_1_11" id="hd_b_ch1.appg.tab3_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall SSI – RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref8">Suzuki 2003</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab3_1_1_1_2 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab3_1_1_1_3 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">395</td><td headers="hd_h_ch1.appg.tab3_1_1_1_4 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.33 (95% CI: 0.79, 2.25)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_5 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 100 people</td><td headers="hd_h_ch1.appg.tab3_1_1_1_6 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 per 100 people (9, 25)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_7 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_8 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_9 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab3_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_10 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch1.appg.tab3_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_11 hd_b_ch1.appg.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_h_ch1.appg.tab3_1_1_1_2 hd_h_ch1.appg.tab3_1_1_1_3 hd_h_ch1.appg.tab3_1_1_1_4 hd_h_ch1.appg.tab3_1_1_1_5 hd_h_ch1.appg.tab3_1_1_1_6 hd_h_ch1.appg.tab3_1_1_1_7 hd_h_ch1.appg.tab3_1_1_1_8 hd_h_ch1.appg.tab3_1_1_1_9 hd_h_ch1.appg.tab3_1_1_1_10 hd_h_ch1.appg.tab3_1_1_1_11" id="hd_b_ch1.appg.tab3_1_1_3_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall superficial SSI–RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref8">Suzuki 2003</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab3_1_1_1_2 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab3_1_1_1_3 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">395</td><td headers="hd_h_ch1.appg.tab3_1_1_1_4 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.70 (95% CI: 0.25, 1.92)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_5 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab3_1_1_1_6 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (1, 3)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_7 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_8 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_9 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab3_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_10 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch1.appg.tab3_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_11 hd_b_ch1.appg.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_h_ch1.appg.tab3_1_1_1_2 hd_h_ch1.appg.tab3_1_1_1_3 hd_h_ch1.appg.tab3_1_1_1_4 hd_h_ch1.appg.tab3_1_1_1_5 hd_h_ch1.appg.tab3_1_1_1_6 hd_h_ch1.appg.tab3_1_1_1_7 hd_h_ch1.appg.tab3_1_1_1_8 hd_h_ch1.appg.tab3_1_1_1_9 hd_h_ch1.appg.tab3_1_1_1_10 hd_h_ch1.appg.tab3_1_1_1_11" id="hd_b_ch1.appg.tab3_1_1_5_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall deep SSI–RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref8">Suzuki 2003</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab3_1_1_1_2 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab3_1_1_1_3 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">395</td><td headers="hd_h_ch1.appg.tab3_1_1_1_4 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.77 (95% CI: 0.92, 3.42)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_5 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 per 100 people</td><td headers="hd_h_ch1.appg.tab3_1_1_1_6 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 100 people (6, 22)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_7 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_8 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_9 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab3_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_10 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab3_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_11 hd_b_ch1.appg.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_h_ch1.appg.tab3_1_1_1_2 hd_h_ch1.appg.tab3_1_1_1_3 hd_h_ch1.appg.tab3_1_1_1_4 hd_h_ch1.appg.tab3_1_1_1_5 hd_h_ch1.appg.tab3_1_1_1_6 hd_h_ch1.appg.tab3_1_1_1_7 hd_h_ch1.appg.tab3_1_1_1_8 hd_h_ch1.appg.tab3_1_1_1_9 hd_h_ch1.appg.tab3_1_1_1_10 hd_h_ch1.appg.tab3_1_1_1_11" id="hd_b_ch1.appg.tab3_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref8">Suzuki 2003</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab3_1_1_1_2 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab3_1_1_1_3 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">395</td><td headers="hd_h_ch1.appg.tab3_1_1_1_4 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.47 (95% CI: 0.15, 1.49)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_5 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab3_1_1_1_6 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (1, 7)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_7 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_8 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_9 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab3_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_10 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch1.appg.tab3_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_11 hd_b_ch1.appg.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_h_ch1.appg.tab3_1_1_1_2 hd_h_ch1.appg.tab3_1_1_1_3 hd_h_ch1.appg.tab3_1_1_1_4 hd_h_ch1.appg.tab3_1_1_1_5 hd_h_ch1.appg.tab3_1_1_1_6 hd_h_ch1.appg.tab3_1_1_1_7 hd_h_ch1.appg.tab3_1_1_1_8 hd_h_ch1.appg.tab3_1_1_1_9 hd_h_ch1.appg.tab3_1_1_1_10 hd_h_ch1.appg.tab3_1_1_1_11" id="hd_b_ch1.appg.tab3_1_1_9_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall nosocomial infections - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab3_1_1_1_1 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref8">Suzuki 2003</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab3_1_1_1_2 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab3_1_1_1_3 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">395</td><td headers="hd_h_ch1.appg.tab3_1_1_1_4 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.70 (95% CI: 0.20, 2.43)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_5 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people</td><td headers="hd_h_ch1.appg.tab3_1_1_1_6 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (0, 6)</td><td headers="hd_h_ch1.appg.tab3_1_1_1_7 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_8 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab3_1_1_1_9 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab3_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_10 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch1.appg.tab3_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab3_1_1_1_11 hd_b_ch1.appg.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="ch1.appg.tab3_1"><p class="no_margin">Inconsistency not applicable</p></div></dd><dt>2</dt><dd><div id="ch1.appg.tab3_2"><p class="no_margin">95% confidence interval crosses both ends of a defined MID interval (0.8, 1.25). Downgrade 2 levels.</p></div></dd><dt>3</dt><dd><div id="ch1.appg.tab3_3"><p class="no_margin">95% confidence interval crosses one end of a defined MID interval (0.8, 1.25). Downgrade 1 level.</p></div></dd><dt>*</dt><dd><div id="ch1.appg.tab3_4"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 100</p></div></dd></dl></div></div></div></div></div><div id="ch1.appg.s3"><h4>G.3. Mupirocin versus 5% povidone iodine</h4><div id="ch1.appg.s3.1"><h5>Outcomes in whole population</h5><div id="ch1.appg.tab4" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appg.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appg.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_ch1.appg.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_ch1.appg.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_ch1.appg.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_ch1.appg.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: control</th><th id="hd_h_ch1.appg.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: intervention (95% CI)</th><th id="hd_h_ch1.appg.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_ch1.appg.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_ch1.appg.tab4_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_ch1.appg.tab4_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_ch1.appg.tab4_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_ch1.appg.tab4_1_1_1_1 hd_h_ch1.appg.tab4_1_1_1_2 hd_h_ch1.appg.tab4_1_1_1_3 hd_h_ch1.appg.tab4_1_1_1_4 hd_h_ch1.appg.tab4_1_1_1_5 hd_h_ch1.appg.tab4_1_1_1_6 hd_h_ch1.appg.tab4_1_1_1_7 hd_h_ch1.appg.tab4_1_1_1_8 hd_h_ch1.appg.tab4_1_1_1_9 hd_h_ch1.appg.tab4_1_1_1_10 hd_h_ch1.appg.tab4_1_1_1_11" id="hd_b_ch1.appg.tab4_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall deep SSI–RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab4_1_1_1_1 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref5">Philips 2014</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab4_1_1_1_2 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab4_1_1_1_3 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1697</td><td headers="hd_h_ch1.appg.tab4_1_1_1_4 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 2.30 (95% CI: 0.89, 5.95)</td><td headers="hd_h_ch1.appg.tab4_1_1_1_5 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people</td><td headers="hd_h_ch1.appg.tab4_1_1_1_6 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (1,4)</td><td headers="hd_h_ch1.appg.tab4_1_1_1_7 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab4_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_8 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab4_1_1_1_9 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab4_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_10 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab4_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_11 hd_b_ch1.appg.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab4_1_1_1_1 hd_h_ch1.appg.tab4_1_1_1_2 hd_h_ch1.appg.tab4_1_1_1_3 hd_h_ch1.appg.tab4_1_1_1_4 hd_h_ch1.appg.tab4_1_1_1_5 hd_h_ch1.appg.tab4_1_1_1_6 hd_h_ch1.appg.tab4_1_1_1_7 hd_h_ch1.appg.tab4_1_1_1_8 hd_h_ch1.appg.tab4_1_1_1_9 hd_h_ch1.appg.tab4_1_1_1_10 hd_h_ch1.appg.tab4_1_1_1_11" id="hd_b_ch1.appg.tab4_1_1_3_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus deep SSI – RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab4_1_1_1_1 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1</p>
|
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<p>
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<a class="bk_pop" href="#ch1.appl.ref5">Philips 2014</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab4_1_1_1_2 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab4_1_1_1_3 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1697</td><td headers="hd_h_ch1.appg.tab4_1_1_1_4 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 4.92 (95% CI: 0.58, 42.06)</td><td headers="hd_h_ch1.appg.tab4_1_1_1_5 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 100 people</td><td headers="hd_h_ch1.appg.tab4_1_1_1_6 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people (0, 5)</td><td headers="hd_h_ch1.appg.tab4_1_1_1_7 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab4_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_8 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab4_1_1_1_9 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab4_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_10 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab4_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_11 hd_b_ch1.appg.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr><tr><th headers="hd_h_ch1.appg.tab4_1_1_1_1 hd_h_ch1.appg.tab4_1_1_1_2 hd_h_ch1.appg.tab4_1_1_1_3 hd_h_ch1.appg.tab4_1_1_1_4 hd_h_ch1.appg.tab4_1_1_1_5 hd_h_ch1.appg.tab4_1_1_1_6 hd_h_ch1.appg.tab4_1_1_1_7 hd_h_ch1.appg.tab4_1_1_1_8 hd_h_ch1.appg.tab4_1_1_1_9 hd_h_ch1.appg.tab4_1_1_1_10 hd_h_ch1.appg.tab4_1_1_1_11" id="hd_b_ch1.appg.tab4_1_1_5_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">MRSA deep SSI – RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab4_1_1_1_1 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref5">Philips 2014</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab4_1_1_1_2 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab4_1_1_1_3 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1697</td><td headers="hd_h_ch1.appg.tab4_1_1_1_4 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.98 (95% CI: 0.06, 15.72)</td><td headers="hd_h_ch1.appg.tab4_1_1_1_5 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 in 100 people</td><td headers="hd_h_ch1.appg.tab4_1_1_1_6 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 in 100 people (0, 19)<sup><a class="bk_pop" href="#ch1.appg.tab4_7">**</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_7 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab4_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_8 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab4_1_1_1_9 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab4_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_10 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab4_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_11 hd_b_ch1.appg.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr><tr><th headers="hd_h_ch1.appg.tab4_1_1_1_1 hd_h_ch1.appg.tab4_1_1_1_2 hd_h_ch1.appg.tab4_1_1_1_3 hd_h_ch1.appg.tab4_1_1_1_4 hd_h_ch1.appg.tab4_1_1_1_5 hd_h_ch1.appg.tab4_1_1_1_6 hd_h_ch1.appg.tab4_1_1_1_7 hd_h_ch1.appg.tab4_1_1_1_8 hd_h_ch1.appg.tab4_1_1_1_9 hd_h_ch1.appg.tab4_1_1_1_10 hd_h_ch1.appg.tab4_1_1_1_11" id="hd_b_ch1.appg.tab4_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">MSSA deep SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab4_1_1_1_1 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref5">Philips 2014</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab4_1_1_1_2 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab4_1_1_1_3 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1697</td><td headers="hd_h_ch1.appg.tab4_1_1_1_4 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 8.86 (95% CI: 0.48, 164.37)</td><td headers="hd_h_ch1.appg.tab4_1_1_1_5 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not calculable<sup><a class="bk_pop" href="#ch1.appg.tab4_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_6 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not calculable<sup><a class="bk_pop" href="#ch1.appg.tab4_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_7 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab4_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_8 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab4_1_1_1_9 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab4_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_10 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab4_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab4_1_1_1_11 hd_b_ch1.appg.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="ch1.appg.tab4_1"><p class="no_margin">Study demonstrated unclear random sequence generation, allocation concealment and blinding of outcome assessment. Downgrade 1 level for serious risk of bias.</p></div></dd><dt>2</dt><dd><div id="ch1.appg.tab4_2"><p class="no_margin">Inconsistency not applicable</p></div></dd><dt>3</dt><dd><div id="ch1.appg.tab4_3"><p class="no_margin">95% confidence interval crosses one end of a defined MID interval (0.8, 1.25). Downgrade 1 level.</p></div></dd><dt>4</dt><dd><div id="ch1.appg.tab4_4"><p class="no_margin">95% confidence interval crosses both ends of a defined MID interval (0.8, 1.25). Downgrade 2 levels.</p></div></dd><dt>5</dt><dd><div id="ch1.appg.tab4_5"><p class="no_margin">The absolute risk was not calculable as there were no events in the control arm.</p></div></dd><dt>*</dt><dd><div id="ch1.appg.tab4_6"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 100</p></div></dd><dt>**</dt><dd><div id="ch1.appg.tab4_7"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 1000</p></div></dd></dl></div></div></div></div></div><div id="ch1.appg.s4"><h4>G.4. Mupirocin and chlorhexidine body wash vs No nasal decontamination</h4><div id="ch1.appg.s4.1"><h5>Outcomes in S. aureus carriers</h5><div id="ch1.appg.tab5" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appg.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appg.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_ch1.appg.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_ch1.appg.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_ch1.appg.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_ch1.appg.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: control<sup><a class="bk_pop" href="#ch1.appg.tab5_8">*</a></sup></th><th id="hd_h_ch1.appg.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: intervention (95% CI)</th><th id="hd_h_ch1.appg.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_ch1.appg.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_ch1.appg.tab5_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_ch1.appg.tab5_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_ch1.appg.tab5_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_h_ch1.appg.tab5_1_1_1_2 hd_h_ch1.appg.tab5_1_1_1_3 hd_h_ch1.appg.tab5_1_1_1_4 hd_h_ch1.appg.tab5_1_1_1_5 hd_h_ch1.appg.tab5_1_1_1_6 hd_h_ch1.appg.tab5_1_1_1_7 hd_h_ch1.appg.tab5_1_1_1_8 hd_h_ch1.appg.tab5_1_1_1_9 hd_h_ch1.appg.tab5_1_1_1_10 hd_h_ch1.appg.tab5_1_1_1_11" id="hd_b_ch1.appg.tab5_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall deep SSI (PJI) – RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref7">Sousa 2016</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab5_1_1_1_2 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab5_1_1_1_3 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">228</td><td headers="hd_h_ch1.appg.tab5_1_1_1_4 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.78 (95% CI: 0.20, 3.04)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_5 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab5_1_1_1_6 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (1, 15)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_7 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_8 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab5_1_1_1_9 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab5_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_10 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch1.appg.tab5_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_11 hd_b_ch1.appg.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr><tr><th headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_h_ch1.appg.tab5_1_1_1_2 hd_h_ch1.appg.tab5_1_1_1_3 hd_h_ch1.appg.tab5_1_1_1_4 hd_h_ch1.appg.tab5_1_1_1_5 hd_h_ch1.appg.tab5_1_1_1_6 hd_h_ch1.appg.tab5_1_1_1_7 hd_h_ch1.appg.tab5_1_1_1_8 hd_h_ch1.appg.tab5_1_1_1_9 hd_h_ch1.appg.tab5_1_1_1_10 hd_h_ch1.appg.tab5_1_1_1_11" id="hd_b_ch1.appg.tab5_1_1_3_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus deep SSI (PJI) – RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref7">Sousa 2016</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab5_1_1_1_2 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab5_1_1_1_3 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">228</td><td headers="hd_h_ch1.appg.tab5_1_1_1_4 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.04 (95% CI: 0.18, 6.11)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_5 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people</td><td headers="hd_h_ch1.appg.tab5_1_1_1_6 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (0, 17)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_7 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_8 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab5_1_1_1_9 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab5_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_10 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch1.appg.tab5_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_11 hd_b_ch1.appg.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr><tr><th headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_h_ch1.appg.tab5_1_1_1_2 hd_h_ch1.appg.tab5_1_1_1_3 hd_h_ch1.appg.tab5_1_1_1_4 hd_h_ch1.appg.tab5_1_1_1_5 hd_h_ch1.appg.tab5_1_1_1_6 hd_h_ch1.appg.tab5_1_1_1_7 hd_h_ch1.appg.tab5_1_1_1_8 hd_h_ch1.appg.tab5_1_1_1_9 hd_h_ch1.appg.tab5_1_1_1_10 hd_h_ch1.appg.tab5_1_1_1_11" id="hd_b_ch1.appg.tab5_1_1_5_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI during postoperative period in S. aureus carriers – RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref9">Tai 2013</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab5_1_1_1_2 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab5_1_1_1_3 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">203</td><td headers="hd_h_ch1.appg.tab5_1_1_1_4 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.36 (95% CI: 0.12, 1.09)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_5 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 100 people</td><td headers="hd_h_ch1.appg.tab5_1_1_1_6 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people (1, 12)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_7 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_8 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_9 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab5_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_10 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_6">6</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_11 hd_b_ch1.appg.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr><tr><th headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_h_ch1.appg.tab5_1_1_1_2 hd_h_ch1.appg.tab5_1_1_1_3 hd_h_ch1.appg.tab5_1_1_1_4 hd_h_ch1.appg.tab5_1_1_1_5 hd_h_ch1.appg.tab5_1_1_1_6 hd_h_ch1.appg.tab5_1_1_1_7 hd_h_ch1.appg.tab5_1_1_1_8 hd_h_ch1.appg.tab5_1_1_1_9 hd_h_ch1.appg.tab5_1_1_1_10 hd_h_ch1.appg.tab5_1_1_1_11" id="hd_b_ch1.appg.tab5_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">MRSA SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1</p>
|
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<p>
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<a class="bk_pop" href="#ch1.appl.ref9">Tai 2013</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab5_1_1_1_2 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab5_1_1_1_3 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">203</td><td headers="hd_h_ch1.appg.tab5_1_1_1_4 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 4.95 (95% CI: 0.24, 101.87)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_5 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not calculable<sup><a class="bk_pop" href="#ch1.appg.tab5_7">7</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_6 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not calculable<sup><a class="bk_pop" href="#ch1.appg.tab5_7">7</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_7 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_8 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_9 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab5_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_10 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch1.appg.tab5_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_11 hd_b_ch1.appg.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr><tr><th headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_h_ch1.appg.tab5_1_1_1_2 hd_h_ch1.appg.tab5_1_1_1_3 hd_h_ch1.appg.tab5_1_1_1_4 hd_h_ch1.appg.tab5_1_1_1_5 hd_h_ch1.appg.tab5_1_1_1_6 hd_h_ch1.appg.tab5_1_1_1_7 hd_h_ch1.appg.tab5_1_1_1_8 hd_h_ch1.appg.tab5_1_1_1_9 hd_h_ch1.appg.tab5_1_1_1_10 hd_h_ch1.appg.tab5_1_1_1_11" id="hd_b_ch1.appg.tab5_1_1_9_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">MSSA SSI - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab5_1_1_1_1 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref9">Tai 2013</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab5_1_1_1_2 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab5_1_1_1_3 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">203</td><td headers="hd_h_ch1.appg.tab5_1_1_1_4 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.18 (95% CI: 0.04, 0.79)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_5 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 100 people</td><td headers="hd_h_ch1.appg.tab5_1_1_1_6 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 (0, 9)</td><td headers="hd_h_ch1.appg.tab5_1_1_1_7 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_8 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab5_5">5</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_9 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab5_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab5_1_1_1_10 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab5_1_1_1_11 hd_b_ch1.appg.tab5_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="ch1.appg.tab5_1"><p class="no_margin">Downgrade 2 levels for very serious risk of bias due unclear allocation concealment and blinding of outcome assessment. Furthermore, intention to treat analysis not conducted.</p></div></dd><dt>2</dt><dd><div id="ch1.appg.tab5_2"><p class="no_margin">Inconsistency not applicable</p></div></dd><dt>3</dt><dd><div id="ch1.appg.tab5_3"><p class="no_margin">95% confidence interval crosses both ends of a defined MID interval (0.8, 1.25). Downgrade 2 levels.</p></div></dd><dt>4</dt><dd><div id="ch1.appg.tab5_4"><p class="no_margin">Downgrade 1 level for serious risk of bias due to unclear random sequence generation, allocation concealment and blinding of outcome assessment.</p></div></dd><dt>5</dt><dd><div id="ch1.appg.tab5_5"><p class="no_margin">Follow-up of SSI and criteria used to define SSI was not specified. Downgrade 1 level.</p></div></dd><dt>6</dt><dd><div id="ch1.appg.tab5_6"><p class="no_margin">95% confidence interval crosses one end of a defined MID interval (0.8, 1.25). Downgrade 1 level.</p></div></dd><dt>7</dt><dd><div id="ch1.appg.tab5_7"><p class="no_margin">The absolute risk was not calculable as there were no events in the control arm.</p></div></dd><dt>*</dt><dd><div id="ch1.appg.tab5_8"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 100</p></div></dd></dl></div></div></div></div></div><div id="ch1.appg.s5"><h4>G.5. Mupirocin and chlorhexidine body wash vs placebo</h4><div id="ch1.appg.s5.1"><h5>Outcomes in S. aureus carriers</h5><div id="ch1.appg.tab6" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appg.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appg.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_ch1.appg.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_ch1.appg.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_ch1.appg.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_ch1.appg.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: control<sup><a class="bk_pop" href="#ch1.appg.tab6_4">*</a></sup></th><th id="hd_h_ch1.appg.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: intervention (95% CI)</th><th id="hd_h_ch1.appg.tab6_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_ch1.appg.tab6_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_ch1.appg.tab6_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_ch1.appg.tab6_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_ch1.appg.tab6_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_h_ch1.appg.tab6_1_1_1_2 hd_h_ch1.appg.tab6_1_1_1_3 hd_h_ch1.appg.tab6_1_1_1_4 hd_h_ch1.appg.tab6_1_1_1_5 hd_h_ch1.appg.tab6_1_1_1_6 hd_h_ch1.appg.tab6_1_1_1_7 hd_h_ch1.appg.tab6_1_1_1_8 hd_h_ch1.appg.tab6_1_1_1_9 hd_h_ch1.appg.tab6_1_1_1_10 hd_h_ch1.appg.tab6_1_1_1_11" id="hd_b_ch1.appg.tab6_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI–RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab6_1_1_1_2 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab6_1_1_1_3 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">808 surgical patients</td><td headers="hd_h_ch1.appg.tab6_1_1_1_4 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.32 (95% CI: 0.16, 0.62)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_5 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 per 100 people</td><td headers="hd_h_ch1.appg.tab6_1_1_1_6 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (1, 5)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_7 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_8 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_9 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab6_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_10 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_11 hd_b_ch1.appg.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_h_ch1.appg.tab6_1_1_1_2 hd_h_ch1.appg.tab6_1_1_1_3 hd_h_ch1.appg.tab6_1_1_1_4 hd_h_ch1.appg.tab6_1_1_1_5 hd_h_ch1.appg.tab6_1_1_1_6 hd_h_ch1.appg.tab6_1_1_1_7 hd_h_ch1.appg.tab6_1_1_1_8 hd_h_ch1.appg.tab6_1_1_1_9 hd_h_ch1.appg.tab6_1_1_1_10 hd_h_ch1.appg.tab6_1_1_1_11" id="hd_b_ch1.appg.tab6_1_1_3_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus superficial SSI–RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab6_1_1_1_2 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab6_1_1_1_3 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">808 surgical patients</td><td headers="hd_h_ch1.appg.tab6_1_1_1_4 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.45 (95% CI: 0.18, 1.11)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_5 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab6_1_1_1_6 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (1, 4)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_7 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_8 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_9 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab6_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_10 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab6_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_11 hd_b_ch1.appg.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_h_ch1.appg.tab6_1_1_1_2 hd_h_ch1.appg.tab6_1_1_1_3 hd_h_ch1.appg.tab6_1_1_1_4 hd_h_ch1.appg.tab6_1_1_1_5 hd_h_ch1.appg.tab6_1_1_1_6 hd_h_ch1.appg.tab6_1_1_1_7 hd_h_ch1.appg.tab6_1_1_1_8 hd_h_ch1.appg.tab6_1_1_1_9 hd_h_ch1.appg.tab6_1_1_1_10 hd_h_ch1.appg.tab6_1_1_1_11" id="hd_b_ch1.appg.tab6_1_1_5_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus deep SSI – RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab6_1_1_1_2 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab6_1_1_1_3 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">808 surgical patients</td><td headers="hd_h_ch1.appg.tab6_1_1_1_4 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.21 (95% CI: 0.07, 0.62)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_5 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab6_1_1_1_6 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people (0, 3)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_7 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_8 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_9 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab6_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_10 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_11 hd_b_ch1.appg.tab6_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_h_ch1.appg.tab6_1_1_1_2 hd_h_ch1.appg.tab6_1_1_1_3 hd_h_ch1.appg.tab6_1_1_1_4 hd_h_ch1.appg.tab6_1_1_1_5 hd_h_ch1.appg.tab6_1_1_1_6 hd_h_ch1.appg.tab6_1_1_1_7 hd_h_ch1.appg.tab6_1_1_1_8 hd_h_ch1.appg.tab6_1_1_1_9 hd_h_ch1.appg.tab6_1_1_1_10 hd_h_ch1.appg.tab6_1_1_1_11" id="hd_b_ch1.appg.tab6_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus nosocomial infections - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab6_1_1_1_2 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab6_1_1_1_3 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">808 surgical patients</td><td headers="hd_h_ch1.appg.tab6_1_1_1_4 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.43 (95% CI: 0.24, 0.77)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_5 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 per 100 people</td><td headers="hd_h_ch1.appg.tab6_1_1_1_6 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people (2, 7)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_7 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_8 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_9 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab6_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_10 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_11 hd_b_ch1.appg.tab6_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><th headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_h_ch1.appg.tab6_1_1_1_2 hd_h_ch1.appg.tab6_1_1_1_3 hd_h_ch1.appg.tab6_1_1_1_4 hd_h_ch1.appg.tab6_1_1_1_5 hd_h_ch1.appg.tab6_1_1_1_6 hd_h_ch1.appg.tab6_1_1_1_7 hd_h_ch1.appg.tab6_1_1_1_8 hd_h_ch1.appg.tab6_1_1_1_9 hd_h_ch1.appg.tab6_1_1_1_10 hd_h_ch1.appg.tab6_1_1_1_11" id="hd_b_ch1.appg.tab6_1_1_9_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Mortality - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab6_1_1_1_2 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab6_1_1_1_3 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">808 surgical patients</td><td headers="hd_h_ch1.appg.tab6_1_1_1_4 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.49 (955 CI: 0.19, 1.22)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_5 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people</td><td headers="hd_h_ch1.appg.tab6_1_1_1_6 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (1, 6)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_7 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_8 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_9 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab6_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_10 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab6_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_11 hd_b_ch1.appg.tab6_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_h_ch1.appg.tab6_1_1_1_2 hd_h_ch1.appg.tab6_1_1_1_3 hd_h_ch1.appg.tab6_1_1_1_4 hd_h_ch1.appg.tab6_1_1_1_5 hd_h_ch1.appg.tab6_1_1_1_6 hd_h_ch1.appg.tab6_1_1_1_7 hd_h_ch1.appg.tab6_1_1_1_8 hd_h_ch1.appg.tab6_1_1_1_9 hd_h_ch1.appg.tab6_1_1_1_10 hd_h_ch1.appg.tab6_1_1_1_11" id="hd_b_ch1.appg.tab6_1_1_11_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Mortality in S. aureus carriers with infection - RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab6_1_1_1_1 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab6_1_1_1_2 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab6_1_1_1_3 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">808 surgical patients</td><td headers="hd_h_ch1.appg.tab6_1_1_1_4 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.28 (95% CI: 0.03, 2.66)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_5 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people</td><td headers="hd_h_ch1.appg.tab6_1_1_1_6 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 100 people (0, 2)</td><td headers="hd_h_ch1.appg.tab6_1_1_1_7 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_8 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab6_1_1_1_9 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab6_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_10 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#ch1.appg.tab6_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab6_1_1_1_11 hd_b_ch1.appg.tab6_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="ch1.appg.tab6_1"><p class="no_margin">Inconsistency not applicable</p></div></dd><dt>2</dt><dd><div id="ch1.appg.tab6_2"><p class="no_margin">95% confidence interval crosses one end of a defined MID interval (0.8, 1.25). Downgrade 1 level.</p></div></dd><dt>3</dt><dd><div id="ch1.appg.tab6_3"><p class="no_margin">95% confidence interval crosses both ends of a defined MID interval (0.8, 1.25). Downgrade 2 levels.</p></div></dd><dt>*</dt><dd><div id="ch1.appg.tab6_4"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 100</p></div></dd></dl></div></div></div></div></div><div id="ch1.appg.s6"><h4>G.6. Mupirocin (with or without chlorhexidine body wash) vs all non-active interventions</h4><p><i>Following meta-analysis was conducted to support the economic evaluation</i>.</p><div id="ch1.appg.s6.1"><h5>Outcomes in S. aureus carriers</h5><div id="ch1.appg.tab7" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appg.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appg.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_ch1.appg.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_ch1.appg.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_ch1.appg.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_ch1.appg.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: control<sup><a class="bk_pop" href="#ch1.appg.tab7_2">*</a></sup></th><th id="hd_h_ch1.appg.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: intervention (95% CI)</th><th id="hd_h_ch1.appg.tab7_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_ch1.appg.tab7_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_ch1.appg.tab7_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_ch1.appg.tab7_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_ch1.appg.tab7_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_ch1.appg.tab7_1_1_1_1 hd_h_ch1.appg.tab7_1_1_1_2 hd_h_ch1.appg.tab7_1_1_1_3 hd_h_ch1.appg.tab7_1_1_1_4 hd_h_ch1.appg.tab7_1_1_1_5 hd_h_ch1.appg.tab7_1_1_1_6 hd_h_ch1.appg.tab7_1_1_1_7 hd_h_ch1.appg.tab7_1_1_1_8 hd_h_ch1.appg.tab7_1_1_1_9 hd_h_ch1.appg.tab7_1_1_1_10 hd_h_ch1.appg.tab7_1_1_1_11" id="hd_b_ch1.appg.tab7_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI–RR <1 favours mupirocin</th></tr><tr><td headers="hd_h_ch1.appg.tab7_1_1_1_1 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>5</p>
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<p>
|
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<a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a>
|
|
</p>
|
|
<p>
|
|
<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer 2002</a>
|
|
</p>
|
|
<p>
|
|
<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka 2006</a>
|
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</p>
|
|
<p>
|
|
<a class="bk_pop" href="#ch1.appl.ref4">Perl 2002</a>
|
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</p>
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<p>
|
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<a class="bk_pop" href="#ch1.appl.ref9">Tai 2013</a>
|
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</p>
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</td><td headers="hd_h_ch1.appg.tab7_1_1_1_2 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab7_1_1_1_3 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2329</td><td headers="hd_h_ch1.appg.tab7_1_1_1_4 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.48 (95% CI: 0.33, 0.70)</td><td headers="hd_h_ch1.appg.tab7_1_1_1_5 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 per 100 people</td><td headers="hd_h_ch1.appg.tab7_1_1_1_6 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (2,5)</td><td headers="hd_h_ch1.appg.tab7_1_1_1_7 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab7_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab7_1_1_1_8 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab7_1_1_1_9 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab7_1_1_1_10 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab7_1_1_1_11 hd_b_ch1.appg.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="ch1.appg.tab7_1"><p class="no_margin">Greater than 33.3% of the weight in the meta-analysis came from a study at moderate risk of bias. Downgrade 1 level for serious risk of bias.</p></div></dd><dt>*</dt><dd><div id="ch1.appg.tab7_2"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 100</p></div></dd></dl></div></div></div></div></div><div id="ch1.appg.s7"><h4>G.7. Chlorhexidine vs. placebo</h4><div id="ch1.appg.s7.1"><h5>In whole population</h5><div id="ch1.appg.tab8" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appg.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appg.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">No. of studies</th><th id="hd_h_ch1.appg.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study design</th><th id="hd_h_ch1.appg.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_ch1.appg.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95% CI)</th><th id="hd_h_ch1.appg.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: control<sup><a class="bk_pop" href="#ch1.appg.tab8_5">*</a></sup></th><th id="hd_h_ch1.appg.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Absolute risk: intervention (95% CI)</th><th id="hd_h_ch1.appg.tab8_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_ch1.appg.tab8_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_ch1.appg.tab8_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_ch1.appg.tab8_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_ch1.appg.tab8_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_1_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall SSI–RR <1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1</p>
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<p>
|
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.89 (95% CI 0.62, 1.29)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 per 100 people (7, 14)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_3_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall deep SSI–RR <1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.36 (95% CI 0.17, 0.77)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (1, 4)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_5_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">S. aureus SSI–RR <1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.77 (95% CI 0.45, 1.31)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 per 100 people (3, 8)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_7_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Overall nosocomial infections (lower respiratory tract infection, urinary tract infection, bacteraemia and SSI) - RR <1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.68 (95% CI 0.56, 0.84)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 per 100 people (20, 29)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_9_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Nosocomial infection : LRTI - RR <1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1</p>
|
|
<p>
|
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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|
</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.59 (95% CI 0.42, 0.83)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 per 100 people (7, 13)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_11_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Nosocomial infection : UTI - RR <1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1</p>
|
|
<p>
|
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.64 (95% CI 0.33, 1.25)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 per 100 people (1, 6)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_13_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Nosocomial infection : bacteraemia - RR <1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1</p>
|
|
<p>
|
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.51 (95% CI 0.23, 1.14)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people (1, 4)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_4">4</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_15_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Mortality - RR <1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.29 (95% CI 0.45, 3.76)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 per 100 people 91, 5)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_17_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Mean hospital Stay–effect size below 0 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD −7.70 (95% CI −9.96, 5.44)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><th headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_h_ch1.appg.tab8_1_1_1_2 hd_h_ch1.appg.tab8_1_1_1_3 hd_h_ch1.appg.tab8_1_1_1_4 hd_h_ch1.appg.tab8_1_1_1_5 hd_h_ch1.appg.tab8_1_1_1_6 hd_h_ch1.appg.tab8_1_1_1_7 hd_h_ch1.appg.tab8_1_1_1_8 hd_h_ch1.appg.tab8_1_1_1_9 hd_h_ch1.appg.tab8_1_1_1_10 hd_h_ch1.appg.tab8_1_1_1_11" id="hd_b_ch1.appg.tab8_1_1_19_1" colspan="11" rowspan="1" style="text-align:left;vertical-align:middle;">Hospital Readmission – RR< 1 favours chlorhexidine</th></tr><tr><td headers="hd_h_ch1.appg.tab8_1_1_1_1 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>1</p>
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<p>
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<a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a>
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</p>
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</td><td headers="hd_h_ch1.appg.tab8_1_1_1_2 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCT</td><td headers="hd_h_ch1.appg.tab8_1_1_1_3 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">954</td><td headers="hd_h_ch1.appg.tab8_1_1_1_4 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.80 (95% CI 0.44, 1.45)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_5 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 per 100 people</td><td headers="hd_h_ch1.appg.tab8_1_1_1_6 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 per 100 people (2, 7)</td><td headers="hd_h_ch1.appg.tab8_1_1_1_7 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_ch1.appg.tab8_1_1_1_8 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_1">1</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_9 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NA<sup><a class="bk_pop" href="#ch1.appg.tab8_2">2</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_10 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Serious<sup><a class="bk_pop" href="#ch1.appg.tab8_3">3</a></sup></td><td headers="hd_h_ch1.appg.tab8_1_1_1_11 hd_b_ch1.appg.tab8_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="ch1.appg.tab8_1"><p class="no_margin">Downgrade 1 level for serious indirectness. In the study chlorhexidine was used as a nasal gel and mouthwash.</p></div></dd><dt>2</dt><dd><div id="ch1.appg.tab8_2"><p class="no_margin">Inconsistency not applicable.</p></div></dd><dt>3</dt><dd><div id="ch1.appg.tab8_3"><p class="no_margin">95% confidence interval crosses both ends of a defined MID interval (0.8, 1.25). Downgrade 2 levels.</p></div></dd><dt>4</dt><dd><div id="ch1.appg.tab8_4"><p class="no_margin">95% confidence interval crosses one end of a defined MID interval (0.8, 1.25). Downgrade 1 level.</p></div></dd><dt>*</dt><dd><div id="ch1.appg.tab8_5"><p class="no_margin">Derived by taking the overall number of event/ total number of participants and multiplying by 100</p></div></dd></dl></div></div></div></div></div></div><div id="ch1.apph"><h3>Appendix H. Economic evidence tables</h3><p id="ch1.apph.et1"><a href="/books/NBK569834/bin/ch1-apph-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (248K)</span></p></div><div id="ch1.appi"><h3>Appendix I. Economic evidence study selection</h3><div id="ch1.appi.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20ch1appif1&p=BOOKS&id=569834_ch1appif1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1appif1.jpg" alt="Image ch1appif1" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="ch1.appj"><h3>Appendix J. Excluded studies</h3><div id="ch1.appj.s1"><h4>Clinical studies</h4><div id="ch1.appj.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Short Title</th><th id="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Title</th><th id="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reason for Exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref10">Alexandrou (2008)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre-Operative Reduction of Nasal and Conjunctival Bacterial Flora With the Use of Mupirocin Nasal Ointment: a Comparison of 3 vs. 5 Day Administration of Mupirocin</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l90"><li id="ch1.lt454" class="half_rhythm"><div>Conference abstract</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref11">Anderson (2015)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Efficacy of skin and nasal povidone-iodine preparation against mupirocin-resistant methicillin-resistant Staphylococcus aureus and S. aureus within the anterior nares</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l91"><li id="ch1.lt455" class="half_rhythm"><div>Study does not contain any of the outcomes of interest</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref12">Bebko (2015)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopaedic surgery with hardware implantation</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l92"><li id="ch1.lt456" class="half_rhythm"><div>Not a relevant study design.</div><div>Retrospective review.</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref13">Bryan (2013)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preventing deep wound infection after coronary artery bypass grafting: A review</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l93"><li id="ch1.lt457" class="half_rhythm"><div>Review article but not a systematic review</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref14">Bryce (2014)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nasal photodisinfection and chlorhexidine wipes decrease surgical site infections: a historical control study and propensity analysis</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l94"><li id="ch1.lt458" class="half_rhythm"><div>Study does not contain any relevant interventions</div><div>Study examined intranasal photodisinfection therapy.</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref15">Casewell (1986)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elimination of nasal carriage of Staphylococcus aureus with mupirocin (‘pseudomonic acid’) - A controlled trial</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l95"><li id="ch1.lt459" class="half_rhythm"><div>Does not contain a population of interest</div><div>Study included non-surgical patients.</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref16">Chen (2013)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l96"><li id="ch1.lt460" class="half_rhythm"><div>Study does not contain any of the outcomes of interest</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref17">Cimochowski (2001)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l97"><li id="ch1.lt461" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref18">Dupeyron (2002)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A clinical trial of mupirocin in the eradication of methicillin-resistant Staphylococcus aureus nasal carriage in a digestive disease unit</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<ul id="ch1.l98"><li id="ch1.lt462" class="half_rhythm"><div>Not a relevant study design. Before and after study,</div></li></ul>
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</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref19">Egozi (2015)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nasal carriage of Staphylococcus aureus in patients undergoing caesarean section and surgical site infection: a prospective randomized trial</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l99"><li id="ch1.lt463" class="half_rhythm"><div>Conference abstract</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref20">Fritz (2013)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mupirocin and chlorhexidine resistance in Staphylococcus aureus in patients with community-onset skin and soft tissue infections</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l100"><li id="ch1.lt464" class="half_rhythm"><div>Does not contain a population of interest</div><div>Study includes people with skin and soft tissue infections.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref21">García (2003)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Use of nasal mupirocin for Staphylococcus aureus: effect on nasal carriers and nosocomial infections</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l101"><li id="ch1.lt465" class="half_rhythm"><div>Study not reported in English</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref22">George (2016)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effectiveness of Decolonization With Chlorhexidine and Mupirocin in Reducing Surgical Site Infections: A Systematic Review</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l102"><li id="ch1.lt466" class="half_rhythm"><div>Systematic review did not contain new relevant papers</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<a class="bk_pop" href="#ch1.appl.ref23">Gernaat-van (1998)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prophylactic mupirocin could reduce orthopaedic wound infections. 1,044 patients treated with mupirocin compared with 1,260 historical controls</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l103"><li id="ch1.lt467" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref24">Glotzbec’er (2013)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What’s the evidence? Systematic literature review of risk factors and preventive strategies for surgical site infection following paediatric spine surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l104"><li id="ch1.lt468" class="half_rhythm"><div>Study not relevant to RQ</div><div>Study examined risk factors.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<a class="bk_pop" href="#ch1.appl.ref25">Harold (2017)</a>
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|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multifaceted aseptic protocol decreases surgical site infections following hip arthroplasty</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l105"><li id="ch1.lt469" class="half_rhythm"><div>Not a relevant study design.</div><div>Retrospective review.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref26">Horiuchi (2006)</a>
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|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nasopharyngeal decolonization of methicillin-resistant Staphylococcus aureus can reduce PEG peristomal wound infection</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l106"><li id="ch1.lt470" class="half_rhythm"><div>Does not contain a population of interest</div><div>Study did not contain patients undergoing surgery.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref27">Hudson (1994)</a>
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|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l107"><li id="ch1.lt471" class="half_rhythm"><div>Review article but not a systematic review</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref28">Jabbour (2010)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Does nasal decontamination reduce the incidence of infections after cardiac surgery?</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l108"><li id="ch1.lt472" class="half_rhythm"><div>Study not reported in English</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref29">Kallen (2005)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Perioperative intranasal mupirocin for the prevention of surgical-site infections: systematic review of the literature and meta-analysis</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l109"><li id="ch1.lt473" class="half_rhythm"><div>Systematic review did not contain new relevant papers</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref30">Kawana (1999)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A trial of povidone-iodine (PVP-I) nasal inhalation and gargling to remove potentially pathogenic bacteria colonized in the pharynx</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l110"><li id="ch1.lt474" class="half_rhythm"><div>Study not reported in English</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref31">Kluytmans (1996)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l111"><li id="ch1.lt475" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref32">Krueger (2002)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically III surgical patients: A prospective, stratified, randomized, double-blind, placebo-controlled clinical trial</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l112"><li id="ch1.lt476" class="half_rhythm"><div>Study does not contain any relevant interventions</div><div>Study examined the use of antibiotic prophylaxis only.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref33">Laupland (2003)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Treatment of Staphylococcus aureus Colonization and Prophylaxis for Infection with Topical Intranasal Mupirocin: An Evidence-Based Review</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l113"><li id="ch1.lt477" class="half_rhythm"><div>Review article but not a systematic review</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref34">Lefebvre (2017)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Staphylococcus aureus screening and decolonization reduces the risk of surgical site infections in patients undergoing deep brain stimulation surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l114"><li id="ch1.lt478" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref35">Levy (2013)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relation between nasal carriage of Staphylococcus aureus and surgical site infection in orthopaedic surgery: the role of nasal contamination. A systematic literature review and meta-analysis</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l115"><li id="ch1.lt479" class="half_rhythm"><div>Systematic review did not contain new relevant papers</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref36">Liu (2017)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nasal decontamination for the prevention of surgical site infection in Staphylococcus aureus carriers</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l116"><li id="ch1.lt480" class="half_rhythm"><div class="half_rhythm">Systematic review did not contain new relevant papers</div><div class="half_rhythm">No new studies identified. Included one study which examined an intervention which was not of interest.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref37">Ma (2017)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l117"><li id="ch1.lt481" class="half_rhythm"><div>Systematic review did not contain new relevant papers</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref38">Maiocco (2007)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decontamination of the nasopharynx and oropharynx with chlorhexidine reduced nosocomial infections in cardiac surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l118"><li id="ch1.lt482" class="half_rhythm"><div>Not a relevant study design.</div><div>Commentary on <a class="bk_pop" href="#ch1.appl.ref6">Segers 2006</a> study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref39">Martorell (2004)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgical site infections in cardiac surgery: An 11-year perspective</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l119"><li id="ch1.lt483" class="half_rhythm"><div>Not a relevant study design.</div><div>Retrospective review.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref40">Mehta (2013)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dose-ranging study to assess the application of intranasal 2% mupirocin calcium ointment to eradicate Staphylococcus aureus nasal colonization</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l120"><li id="ch1.lt484" class="half_rhythm"><div>Study does not contain any of the outcomes of interest</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref41">Mehtar (1998)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">New strategies for the use of mupirocin for the prevention of serious infection</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l121"><li id="ch1.lt485" class="half_rhythm"><div>Review article but not a systematic review</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref42">Mody (2003)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mupirocin-Based Decolonization of Staphylococcus aureus Carriers in Residents of 2 Long-Term Care Facilities: A Randomized, Double-Blind, Placebo-Controlled Trial</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l122"><li id="ch1.lt486" class="half_rhythm"><div>Study not relevant to RQ</div><div>Study did not contain surgical patients.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref43">Moon (2010)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reducing hospital-associated infections in Staphylococcus aureus carriers</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l123"><li id="ch1.lt487" class="half_rhythm"><div>Not a relevant study design.</div><div>Summary of <a class="bk_pop" href="#ch1.appl.ref1">Bode 2010</a> study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref44">Moreira (2007)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Efficacy of a program of prevention and control for methicillin-resistant staphylococcus aureus Infections in an intensive-care unit</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l124"><li id="ch1.lt488" class="half_rhythm"><div>Study not relevant to RQ</div><div>Prospective cohort study which included patients hospitalised in ICU.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref45">Nardi (2001)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reduction in gram-positive pneumonia and antibiotic consumption following the use of a SDD protocol including nasal and oral mupirocin</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l125"><li id="ch1.lt489" class="half_rhythm"><div>Does not contain a population of interest</div><div>Study carried out in an intensive care unit.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref46">Perl (2003)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prevention of Staphylococcus aureus infections among surgical patients: beyond traditional perioperative prophylaxis</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l126"><li id="ch1.lt490" class="half_rhythm"><div>Review article but not a systematic review</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref47">Reiser (2017)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l127"><li id="ch1.lt491" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref48">Rezapoor (2017)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Povidone-Iodine-Based Solutions for Decolonization of Nasal Staphylococcus aureus: A Randomized, Prospective, Placebo-Controlled Study</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l128"><li id="ch1.lt492" class="half_rhythm"><div>Study does not contain any of the outcomes of interest</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref49">Ridenour (2007)</a>
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|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l129"><li id="ch1.lt493" class="half_rhythm"><div>Does not contain a population of interest</div><div>Non-surgical patients included.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref50">Ro (2008)</a>
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</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methicillin-resistant Staphylococcus aureus colonization: a review of the literature on prevention and eradication</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l130"><li id="ch1.lt494" class="half_rhythm"><div>Does not contain a population of interest</div><div>Systematic review did not focus on surgical patients.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bk_pop" href="#ch1.appl.ref51">Rohr (2003)</a>
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|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methicillin-resistant Staphylococcus aureus whole-body decolonization among hospitalized patients with variable site colonization by using mupirocin in combination with octenidine dihydrochloride</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l131"><li id="ch1.lt495" class="half_rhythm"><div>Not a relevant study design. Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<a class="bk_pop" href="#ch1.appl.ref52">Sadigursky (2017)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prophylaxis with nasal decolonization in patients submitted to total knee and hip arthroplasty: systematic review and meta-analysis</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l132"><li id="ch1.lt496" class="half_rhythm"><div>Systematic review did not match review protocol</div><div>Systematic review only included observational studies.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref53">Schora (2014)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Impact of Detection, Education, Research and Decolonization without Isolation in Long-term care (DERAIL) on methicillin-resistant Staphylococcus aureus colonization and transmission at 3 long-term care facilities</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l133"><li id="ch1.lt497" class="half_rhythm"><div class="half_rhythm">Study does not contain any relevant interventions</div><div class="half_rhythm">Study focused on a strategy which involved active surveillance using nasal swabs samples, decolonisation of carriers on intervention units, hand hygiene instruction, and enhanced cleaning of the environment.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref55">Schweizer (2012)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgical site infections and their prevention</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l134"><li id="ch1.lt498" class="half_rhythm"><div>Review article but not a systematic review</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref56">Schweizer (2013)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopaedic surgery: systematic review and meta-analysis</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l135"><li id="ch1.lt499" class="half_rhythm"><div>Systematic review did not contain new relevant papers</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref54">Schweizer (2015)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l136"><li id="ch1.lt500" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref57">Segers (2008)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prevention of nosocomial infections after cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine; a prospective, randomised study</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l137"><li id="ch1.lt501" class="half_rhythm"><div>Study not reported in English</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref58">Shrem (2016)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre-caesarean Staphylococcus aureus nasal screening and decolonization: a prospective randomized controlled trial</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l138"><li id="ch1.lt502" class="half_rhythm"><div>Not a relevant study design</div><div>Quasi randomised trial.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref59">Shuman (2012)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preoperative topical antimicrobial decolonization in head and neck surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l139"><li id="ch1.lt503" class="half_rhythm"><div>Not a relevant study design</div><div>Quasi-randomised trial.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref60">Singh (2006)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Impact of an aggressive infection control strategy on endemic Staphylococcus aureus infection in liver transplant recipients</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l140"><li id="ch1.lt504" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref61">Sporer (2016)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Screening and Decolonization to Reduce Surgical Site Infection in Elective Total Joint Arthroplasty</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l141"><li id="ch1.lt505" class="half_rhythm"><div>Not a relevant study design.</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref62">Tai (2012)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A prospective randomised study of Staphylococcus aureus nasal carriage as a major risk factor for infection in Mohs micrographic surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l142"><li id="ch1.lt506" class="half_rhythm"><div>Conference abstract</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref63">Thompson (2013)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decreasing methicillin-resistant Staphylococcus aureus surgical site infections with chlorhexidine and mupirocin</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l143"><li id="ch1.lt507" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref64">Trautmann (2008)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intranasal mupirocin prophylaxis in elective surgery. A review of published studies</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l144"><li id="ch1.lt508" class="half_rhythm"><div>Systematic review did not contain new relevant papers</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref65">van Rijen (2008)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">New approaches to prevention of staphylococcal infection in surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l145"><li id="ch1.lt509" class="half_rhythm"><div>Review article but not a systematic review</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref65">van Rijen (2008)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l146"><li id="ch1.lt510" class="half_rhythm"><div>Systematic review did not contain new relevant papers</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref65">van Rijen (2008)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l147"><li id="ch1.lt511" class="half_rhythm"><div>Systematic review did not match review protocol</div><div>Included studies which examined surgical and non-surgical patients.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref68">Verhoeven (2014)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Detection and clinical relevance of Staphylococcus aureus nasal carriage: an update</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l148"><li id="ch1.lt512" class="half_rhythm"><div>Review article but not a systematic review</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref69">Yano (2000)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preoperative intranasal mupirocin ointment significantly reduces postoperative infection with Staphylococcus aureus in patients undergoing upper gastrointestinal surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l149"><li id="ch1.lt513" class="half_rhythm"><div>Not a relevant study design</div><div>Before and after study.</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref70">Yu (2011)</a>
|
|
</td><td headers="hd_h_ch1.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relationship between nasal colonization of Staphylococcus aureus and nosocomial infection after cardiac surgery</td><td headers="hd_h_ch1.appj.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<ul id="ch1.l150"><li id="ch1.lt514" class="half_rhythm"><div>Study not reported in English</div></li></ul>
|
|
</td></tr></tbody></table></div></div></div><div id="ch1.appj.s2"><h4>Economic studies</h4><div id="ch1.appj.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appj.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appj.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Full title</th><th id="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Primary reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<a class="bk_pop" href="#ch1.appl.ref12">Bebko 2015</a>
|
|
</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bebko SP (2015). Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation. <i>JAMA Surg,</i> 150 (5): 390.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Bilici 2016</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bilici S, Durna YM, Yigit O, et al. (2016). The effect of mupirocin- and fusidic acid-nasal packings, place after septoplasty, on the nasal bacterial profile. <i>Allergy Rhinol,</i> 7 (4): e207–12.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
|
<a class="bk_pop" href="#ch1.appl.ref17">Cimochowski 2001</a>
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</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cimochowsky GE, Harostock MD, Brown R, et al. (2001). Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. <i>Ann Thorac Surg,</i> 71 (5): 1572–9.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Based on non-randomised evidence</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Cunha 2011</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cunha BA, Thekkel V, Schoch P, et al. (2011). Clinical and cost ineffectiveness of preoperative screening for methicillin-resistant Staphylococcus aureus and intranasal mupirocin in preventing methicillin-resistant S aureus infections in cardiothoracic surgery. <i>Am J Infect Control,</i> 39 (3): 243–6.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Based on non-randomised evidence</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Davey 1998</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Davey P (1998). Eradication of nasal carriage of Staphylococcus aureus – is it cost-effective? <i>J Hosp Infect,</i> 40: S31–7.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review article, no additional CUAs</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Gurusamy 2015</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gurusamy KS. Koti R, Wilson P, Davidson BR. (2015). Antibiotic prophylaxis for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) related complications in surgical patients. <i>Cochrane database of systematic reviews,</i> 8.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Hetem 2016</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hetem DJ, Bootsma MCJ, Bonten MJM (2016). Prevention of surgical site infections: decontamination with mupirocin based on preoperative screening for Staphylococcus aureus carriers or universal decontamination? <i>Clin Infect Dis,</i> 62 (5): 631–6.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Huang 2014</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Huang SS, Septimus E, Avery TR, et al. (2014). Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. <i>Inf Control Hosp Epidemiol,</i> 35: S23–31.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Population (general ICU)</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Kerbel 2018</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kerbel YE, Sunkerneni AR, Kirchner GJ, et al. (2018). The cost-effectiveness of preoperative Staphylococcus aureus screening and decolonization in total joint arthroplasty. <i>J Arthroplasty,</i> Epub ahead of print.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Lee 2011</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lee YJ, Chen JZ, Lin HC, et al. (2011). Impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization on MRSA infection, mortality and medical cost: a quasi-experimental study in surgical intensive care unit. <i>Critical Care,</i> 19: 143.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Based on non-randomised evidence</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<a class="bk_pop" href="#ch1.appl.ref36">Liu 2017</a>
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</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Liu Z, Norman G, Iheofor-Ejiofor Z, et al. (2017). Nasal decontamination for the prevention of surgical site infection in Satphylococcus aureus carriers. <i>Cochrane dataset of systematic reviews,</i> 5.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Peng 2017</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Peng HM, Wang LC, Zhai JL, et al. (2017). Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study. <i>Brazilian J Medical Biological Res,</i> 51 (2): e6736.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Piraino 2000</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Piraino B (2000). Staphylococcus aureus infections in dialysis patients: focus on prevention. <i>ASAIO Journal,</i> 46 (5): S13–27.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Shreshta 2003</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shrestha NK, Shermock KM, Gordon SM, et al. (2003). Predictive value and cost-effectiveness analysis of a rapid polymerase chain reaction for preoperative detection of nasal carriage of Staphylococcus aureus. <i>Inf Control Hosp Epidemiol,</i> 24 (5): 327–33.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Stambough 2017</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stambough JB, Nam D, Warren DK, et al. (2017). Decreased hospital costs and surgical site infection incidence with a universal decolonization protocol in primary total joint arthroplasty. <i>J Arthroplasty,</i> 32: 72834.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Based on non-randomised evidence</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Rao 2008</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rao N, Cannella B, Crossett LS, et al. (2008). A preoperative decolonization protocol for Staphylococcus aureus prevents orthopaedic infections. <i>Clin Orthop Relat Res,</i> 466: 1343–8.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Based on non-randomised evidence</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Rieser 2018</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rieser GR, Moskal JT. (2018). Cost efficacy of methicillin-resistant Staphylococcus aureus decolonization with intranasal povidone-iodine. <i>J Arthroplasty,</i> Epub ahead of print..</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Not a full economic evaluation</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Rowbotham 2011</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rowbotham JV, Graves N, Cookson BD, et al. (2011). Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation. <i>BMJ,</i> 343 (7827): d5694.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Population (general ICU)</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Torres 2016</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Torres EG, Lindmair-Snell JM, Langan JW, Burnikel BG (2016). Is preoperative nasal povidone-iodine as efficient and cost-effective as standard methicillin-resistant Staphylococcus aureus screening protocol in total joint arthroplasty? <i>J Arthroplasty,</i> 31 (1): 215–8.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Based on non-randomised evidence</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Vandenbergh 1996</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VandenBergh MFQ, klutymans JAJW, van Hout BA, et al. (1996). Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery. <i>Inf Control Hosp Epidemiol,</i> 17 (12): 786–92.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Based on non-randomised evidence</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Williams 2017</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Williams DM, Miller AO, Henry MW, et al. (2017). Cost-effectiveness of staphylococcus aureus decolonization strategies in high-risk total joint arthroplasty patients. <i>J Arthroplasty,</i> 32 (9): S91–6.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Insufficient information provided</td></tr><tr><td headers="hd_h_ch1.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Ziakas 2015</td><td headers="hd_h_ch1.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ziakas PD, Zacharioudakis IM, Zervou FN, Mylonakis E. Methicillin-resistant Staphylococcus aureus prevention strategies in the ICU: a clinical decision analysis. <i>Crit Care Med,</i> 43 (2): 382–93.</td><td headers="hd_h_ch1.appj.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Population (general ICU)</td></tr></tbody></table></div></div></div></div><div id="ch1.appk"><h3>Appendix K. Research recommendations</h3><div id="ch1.appk.s1"><h4>1. What is the clinical effectiveness of preoperative nasal decolonisation using mupirocin in combination with a chlorhexidine body wash in the whole population?</h4><p>Three studies were identified which examined the clinical effectiveness of nasal decolonisation using mupirocin in combination with a chlorhexidine body wash. Out of the three studies, one study demonstrated a significant reduction in <i>S. aureus</i> SSI (including deep and superficial SSI) and <i>S. aureus</i> nosocomial infections. However, these studies only included people who were identified as <i>S. aureus</i> carriers. Therefore, no information was identified with regards to the effectiveness of this bundled intervention in the whole population.</p><p>Further research is needed using a robust study design such as a health technology assessment to explore the clinical effectiveness of mupirocin with chlorhexidine in the whole population. Studies should also explore the effectiveness of the bundle intervention in different surgical procedures. Studies should be UK based. Research in this area is essential to inform future updates of key recommendations in this guidance which in turn can help improve patient outcomes.</p><div id="ch1.appk.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appk.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appk.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch1.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO</th><td headers="hd_b_ch1.appk.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Population:</b></p><p>People of any age undergoing any surgery, including minimally invasive surgery (arthroscopic, thoracoscopic and laparoscopic surgery)</p><p><b>Interventions:</b>
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<ul id="ch1.l151"><li id="ch1.lt515" class="half_rhythm"><div>Intranasal mupirocin</div></li><li id="ch1.lt516" class="half_rhythm"><div>Intranasal mupirocin with chlorhexidine body wash</div></li></ul></p>
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<p><b>Comparator:</b>
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<ul id="ch1.l152"><li id="ch1.lt517" class="half_rhythm"><div>Placebo</div></li><li id="ch1.lt518" class="half_rhythm"><div>Other decolonisation protocols which include the use of chlorhexidine and neomycin cream (Naseptin), octenisan and other products</div></li><li id="ch1.lt519" class="half_rhythm"><div>No treatment</div></li></ul></p>
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<p><b>Outcomes:</b><ul id="ch1.l153"><li id="ch1.lt520" class="half_rhythm"><div>Surgical site infections (superficial, deep and organ/space SSI), including MRSA and MSSA SSI</div></li><li id="ch1.lt521" class="half_rhythm"><div>Other types of nosocomial infections</div></li><li id="ch1.lt522" class="half_rhythm"><div>Infectious complications such as septicaemia or septic shock</div></li><li id="ch1.lt523" class="half_rhythm"><div>Adverse events such as: antimicrobial resistance (measured using recognised method e.g. PCR)</div></li></ul></p></td></tr><tr><th id="hd_b_ch1.appk.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</th><td headers="hd_b_ch1.appk.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 RCTs of low power</td></tr><tr><th id="hd_b_ch1.appk.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch1.appk.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Randomised controlled trial</td></tr><tr><th id="hd_b_ch1.appk.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other comments</th><td headers="hd_b_ch1.appk.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">These studies should be conducted within UK settings, should take into consideration different surgical procedures and should contain an adequate sample size.</td></tr></tbody></table></div></div></div><div id="ch1.appk.s2"><h4>2. What is the contribution to clinical effectiveness of the timing of nasal decolonisation and body wash for the prevention of surgical site infection?</h4><p>The timing of decolonisation in the studies included in this review ranged from a day before surgery to five days before surgery, however no studies were identified which compared different timings and duration of decolonisation. Therefore no recommendations could be made around when decolonisation should be initiated. Further research is needed using a robust study design to explore the clinical effectiveness of the timing of nasal decolonisation. Studies should be UK based and should consider different surgical procedures. Research in this area is essential to inform future updates of key recommendations in this guidance.</p><div id="ch1.appk.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appk.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appk.tab2_lrgtbl__"><table><tbody><tr><th id="hd_b_ch1.appk.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO</th><td headers="hd_b_ch1.appk.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Population:</b></p><p>People of any age undergoing any surgery, including minimally invasive surgery (arthroscopic, thoracoscopic and laparoscopic surgery)</p><p><b>Interventions:</b></p><p>Following interventions given at different times:
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<ul id="ch1.l154"><li id="ch1.lt524" class="half_rhythm"><div>Intranasal mupirocin</div></li><li id="ch1.lt525" class="half_rhythm"><div>Intranasal mupirocin with body wash or wipes (e.g. chlorhexidine)</div></li><li id="ch1.lt526" class="half_rhythm"><div>Other decolonisation protocols which include the use of chlorhexidine and neomycin cream (Naseptin), octenisan and other products</div></li></ul></p><p><b>Comparator:</b>
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<ul id="ch1.l155"><li id="ch1.lt527" class="half_rhythm"><div>Different timing of nasal decolonisation compared to each other</div></li></ul></p>
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<p><b>Outcomes:</b> other Outcomes<b>es:</b>
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<ul id="ch1.l156"><li id="ch1.lt528" class="half_rhythm"><div>Surgical site infections (superficial, deep and organ/space SSI), including MRSA and MSSA SSI</div></li><li id="ch1.lt529" class="half_rhythm"><div>Other types of nosocomial infections</div></li><li id="ch1.lt530" class="half_rhythm"><div>Infectious complications such as septicaemia or septic shock</div></li><li id="ch1.lt531" class="half_rhythm"><div>Adverse events such as: antimicrobial resistance (measured using recognised method e.g. PCR)</div></li></ul></p></td></tr><tr><th id="hd_b_ch1.appk.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</th><td headers="hd_b_ch1.appk.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No randomised controlled trials were identified.</td></tr><tr><th id="hd_b_ch1.appk.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch1.appk.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Randomised controlled trial</td></tr><tr><th id="hd_b_ch1.appk.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other comments</th><td headers="hd_b_ch1.appk.tab2_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">These studies should be conducted within UK settings, should take into consideration different surgical procedures and should contain an adequate sample size.</td></tr></tbody></table></div></div></div><div id="ch1.appk.s3"><h4>3. Is the use of chlorhexidine body wash associated with increased antimicrobial resistance?</h4><p>In this review, no extractable data was identified on antimicrobial resistance associated with the use of mupirocin. Furthermore, no evidence was identified on the antimicrobial resistance associated with the use of chlorhexidine body wash. Currently, antimicrobial susceptibility associated with the use of mupirocin is measured as part of surveillance, however a similar database has not been established for the use of chlorhexidine. Therefore, surveillance of antimicrobial susceptibility is also needed to examine any increase in resistance. Research in this area is essential to inform future updates of key recommendations in this guidance which in turn can help improve patient outcomes.</p><div id="ch1.appk.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appk.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appk.tab3_lrgtbl__"><table><tbody><tr><th id="hd_b_ch1.appk.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO</th><td headers="hd_b_ch1.appk.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Population:</b></p><p>People of any age undergoing any surgery, including minimally invasive surgery (arthroscopic, thoracoscopic and laparoscopic surgery)</p><p><b>Interventions:</b>
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<ul id="ch1.l157"><li id="ch1.lt532" class="half_rhythm"><div>Chlorhexidine body wash</div></li></ul></p>
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<p><b>Outcomes: Outcomes:</b>
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<ul id="ch1.l158"><li id="ch1.lt533" class="half_rhythm"><div>Antimicrobial resistance measured using in vitro studies which utilise dilution method, PCR or any other recognised method to ascertain resistance.</div></li></ul></p></td></tr><tr><th id="hd_b_ch1.appk.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</th><td headers="hd_b_ch1.appk.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No studies were identified.</td></tr><tr><th id="hd_b_ch1.appk.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch1.appk.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surveillance registry</td></tr><tr><th id="hd_b_ch1.appk.tab3_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other comments</th><td headers="hd_b_ch1.appk.tab3_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This surveillance registry should be maintained within UK settings and should take into consideration different surgical procedures.</td></tr></tbody></table></div></div></div><div id="ch1.appk.s4"><h4>4. What is the effectiveness of decolonisation using alternative interventions in combination with nasal decolonisation in the prevention of surgical site infections when chlorhexidine is contraindicated?</h4><p>In the review, evidence was identified on the effectiveness of the bundled use of mupirocin and chlorhexidine body wash in the prevention of surgical site infection. However, it was identified that in some instances use of chlorhexidine may not be appropriate, such as when a person is sensitive to chlorhexidine. Therefore, further research is needed using a robust study design, to identify alternative interventions for decolonisation. These studies should be conducted in the UK and should take into consideration different surgical procedures. Research in this area can effective intervention to be identified for people presenting with contraindications. This can help improve patient outcomes.</p><div id="ch1.appk.tab4" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.appk.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.appk.tab4_lrgtbl__"><table><tbody><tr><th id="hd_b_ch1.appk.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO</th><td headers="hd_b_ch1.appk.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><b>Population:</b></p><p>People of any age undergoing any surgery, including minimally invasive surgery (arthroscopic, thoracoscopic and laparoscopic surgery)</p><p><b>Interventions:</b></p>
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<p>Nasal decolonisation (which can include the use of mupirocin, chlorhexidine and neomycin cream (Naseptin), octenisan and other products) in combination with body wash using alternative interventions such as:<ul id="ch1.l159"><li id="ch1.lt534" class="half_rhythm"><div>Octenisan</div></li><li id="ch1.lt535" class="half_rhythm"><div>Polyhexanide</div></li></ul></p>
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<p><b>Comparator:</b><ul id="ch1.l160"><li id="ch1.lt536" class="half_rhythm"><div>Placebo</div></li><li id="ch1.lt537" class="half_rhythm"><div>No decolonisation</div></li><li id="ch1.lt538" class="half_rhythm"><div>Different nasal decolonisation protocols</div></li></ul></p>
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<p><b>Outcomes:</b><ul id="ch1.l161"><li id="ch1.lt539" class="half_rhythm"><div>Surgical site infections (superficial, deep and organ/space SSI), including MRSA and MSSA SSI</div></li><li id="ch1.lt540" class="half_rhythm"><div>Other types of nosocomial infections</div></li><li id="ch1.lt541" class="half_rhythm"><div>Infectious complications such as septicaemia or septic shock</div></li><li id="ch1.lt542" class="half_rhythm"><div>Adverse events such as: antimicrobial resistance</div></li></ul></p></td></tr><tr><th id="hd_b_ch1.appk.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</th><td headers="hd_b_ch1.appk.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No studies were identified.</td></tr><tr><th id="hd_b_ch1.appk.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch1.appk.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Randomised controlled trial</td></tr><tr><th id="hd_b_ch1.appk.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other comments</th><td headers="hd_b_ch1.appk.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">These studies should be conducted within UK settings, should take into consideration different surgical procedures and should contain an adequate sample size.</td></tr></tbody></table></div></div></div></div><div id="ch1.appl"><h3>Appendix L. References</h3><div id="ch1.appl.rl.r1"><h4>Included studies</h4><ul class="simple-list"><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref1">Bode
|
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Lonneke G. M, Kluytmans
|
|
Jan A. J. W, Wertheim
|
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Heiman F. L, Bogaers
|
|
Diana, Vandenbroucke-Grauls
|
|
Christina M. J. E, Roosendaal
|
|
Robert, Troelstra
|
|
Annet, Box
|
|
Adrienne T. A, Voss
|
|
Andreas, van der Tweel, Ingeborg, van Belkum, Alex, Verbrugh
|
|
Henri A, and Vos
|
|
Margreet C (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. The New England journal of medicine
|
|
362(1), 9–17 [<a href="https://pubmed.ncbi.nlm.nih.gov/20054045" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20054045</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref2">Kalmeijer
|
|
M D, Coertjens
|
|
H, van Nieuwland-Bollen, P M, Bogaers-Hofman
|
|
D, de Baere, G A J, Stuurman
|
|
A, van Belkum, A, and Kluytmans
|
|
J A. J. W (2002) Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
|
|
35(4), 353–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/12145715" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12145715</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref3">Konvalinka
|
|
A, Errett
|
|
L, and Fong
|
|
I W (2006) Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery. The Journal of hospital infection
|
|
64(2), 162–8 [<a href="/pmc/articles/PMC7132525/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7132525</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16930768" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16930768</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref4">Perl
|
|
Trish M, Cullen
|
|
Joseph J, Wenzel
|
|
Richard P, Zimmerman
|
|
M Bridget, Pfaller
|
|
Michael A, Sheppard
|
|
Deborah, Twombley
|
|
Jennifer, French
|
|
Pamela P, Herwaldt
|
|
Loreen A, Mupirocin, The Risk Of Staphylococcus Aureus Study, and Team (2002) Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. The New England journal of medicine
|
|
346(24), 1871–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/12063371" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12063371</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref5">Phillips
|
|
Michael, Rosenberg
|
|
Andrew, Shopsin
|
|
Bo, Cuff
|
|
Germaine, Skeete
|
|
Faith, Foti
|
|
Alycia, Kraemer
|
|
Kandy, Inglima
|
|
Kenneth, Press
|
|
Robert, and Bosco
|
|
Joseph (2014) Preventing surgical site infections: a randomized, open-label trial of nasal mupirocin ointment and nasal povidone-iodine solution. Infection control and hospital epidemiology
|
|
35(7), 826–32 [<a href="/pmc/articles/PMC4668802/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4668802</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24915210" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24915210</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref6">Segers
|
|
Patrique, Speekenbrink
|
|
Ron G. H, Ubbink
|
|
Dirk T, van Ogtrop, Marc L, de Mol, and Bas A (2006) Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA
|
|
296(20), 2460–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/17119142" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17119142</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref7">Sousa
|
|
Ricardo J. G, Barreira
|
|
Pedro M. B, Leite
|
|
Pedro T. S, Santos
|
|
Ana Claudia M, Ramos
|
|
Maria Helena S. S, and Oliveira
|
|
Antonio F (2016) Preoperative Staphylococcus aureus Screening/Decolonization Protocol Before Total Joint Arthroplasty-Results of a Small Prospective Randomized Trial. The Journal of arthroplasty
|
|
31(1), 234–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/26362785" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26362785</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref8">Suzuki
|
|
Y, Kamigaki
|
|
T, Fujino
|
|
Y, Tominaga
|
|
M, Ku
|
|
Y, and Kuroda
|
|
Y (2003) Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery. The British journal of surgery
|
|
90(9), 1072–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/12945073" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12945073</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref9">Tai
|
|
Yee J, Borchard
|
|
Kate L. A, Gunson
|
|
Todd H, Smith
|
|
Harvey R, and Vinciullo
|
|
Carl (2013) Nasal carriage of Staphylococcus aureus in patients undergoing Mohs micrographic surgery is an important risk factor for postoperative surgical site infection: a prospective randomised study. The Australasian journal of dermatology
|
|
54(2), 109–14 [<a href="https://pubmed.ncbi.nlm.nih.gov/23425142" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23425142</span></a>]</div></li></ul></div><div id="ch1.appl.rl.r2"><h4>Excluded studies</h4><ul class="simple-list"><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref10">Alexandrou
|
|
Tj, Hariprasad
|
|
Sm, and Mieler
|
|
Wf (2008) Pre-Operative Reduction of Nasal and Conjunctival Bacterial Fflora With the Use of Mupirocin Nasal Ointment: a Comparison of 3 vs. 5 Day Administration of Mupirocin. Iovs, ARVO E- abstract 960</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref11">Anderson
|
|
Michele J, David
|
|
Maren L, Scholz
|
|
Matt, Bull
|
|
Sally J, Morse
|
|
Dan, Hulse-Stevens
|
|
Michelle, and Peterson
|
|
Marnie L (2015) Efficacy of skin and nasal povidone-iodine preparation against mupirocin-resistant methicillin-resistant Staphylococcus aureus and S. aureus within the anterior nares. Antimicrobial agents and chemotherapy
|
|
59(5), 2765–73 [<a href="/pmc/articles/PMC4394816/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4394816</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25733504" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25733504</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref12">Bebko
|
|
Serge P, Green
|
|
David M, and Awad
|
|
Samir S (2015) Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation. JAMA surgery
|
|
150(5), 390–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/25738898" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25738898</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref13">Bryan
|
|
C S, and Yarbrough
|
|
W M (2013) Preventing deep wound infection after coronary artery bypass grafting: A review. Texas Heart Institute Journal
|
|
40(2), 125–139 [<a href="/pmc/articles/PMC3649789/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3649789</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23678210" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23678210</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref14">Bryce
|
|
E, Wong
|
|
T, Forrester
|
|
L, Masri
|
|
B, Jeske
|
|
D, Barr
|
|
K, Errico
|
|
S, and Roscoe
|
|
D (2014) Nasal photodisinfection and chlorhexidine wipes decrease surgical site infections: a historical control study and propensity analysis. The Journal of hospital infection
|
|
88(2), 89–95 [<a href="https://pubmed.ncbi.nlm.nih.gov/25171975" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25171975</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref15">Casewell
|
|
M W, and Hill
|
|
R L. R (1986) Elimination of nasal carriage of Staphylococcus aureus with mupirocin (‘pseudomonic acid’) - A controlled trial. Journal of Antimicrobial Chemotherapy
|
|
17(3), 365–372 [<a href="https://pubmed.ncbi.nlm.nih.gov/3084442" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3084442</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref16">Chen
|
|
A F, Heyl
|
|
A E, Xu
|
|
P Z, Rao
|
|
N, and Klatt
|
|
B A (2013) Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients. Journal of Arthroplasty
|
|
28(8 SUPPL), 18–20 [<a href="https://pubmed.ncbi.nlm.nih.gov/23871467" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23871467</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref17">Cimochowski
|
|
G E, Harostock
|
|
M D, Brown
|
|
R, Bernardi
|
|
M, Alonzo
|
|
N, and Coyle
|
|
K (2001) Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. The Annals of thoracic surgery
|
|
71(5), 1572–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/11383802" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11383802</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref18">Dupeyron
|
|
C, Campillo
|
|
B, Bordes
|
|
M, Faubert
|
|
E, Richardet
|
|
J P, and Mangeney
|
|
N (2002) A clinical trial of mupirocin in the eradication of methicillin-resistant Staphylococcus aureus nasal carriage in a digestive disease unit. The Journal of hospital infection
|
|
52(4), 281–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/12473473" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12473473</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref19">Egozi
|
|
T, Shrem
|
|
G, Naeh
|
|
A, Hallak
|
|
M, and Walfisch
|
|
A (2015) Nasal carriage of Staphylococcus aureus in patients undergoing cesarean section and surgical site infection: a prospective randomized trial. American journal of obstetrics and gynecology. 212(1 suppl. 1), S206–s207</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref20">Fritz
|
|
Stephanie A, Hogan
|
|
Patrick G, Camins
|
|
Bernard C, Ainsworth
|
|
Ali J, Patrick
|
|
Carol, Martin
|
|
Madeline S, Krauss
|
|
Melissa J, Rodriguez
|
|
Marcela, and Burnham
|
|
Carey-Ann D (2013) Mupirocin and chlorhexidine resistance in Staphylococcus aureus in patients with community-onset skin and soft tissue infections. Antimicrobial agents and chemotherapy
|
|
57(1), 559–68 [<a href="/pmc/articles/PMC3535967/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3535967</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23147738" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23147738</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref21">García
|
|
Am, Villa
|
|
Mv, Escudero
|
|
Me, Gómez
|
|
P, Vélez
|
|
Mm, Múnera
|
|
Mi, and Franco
|
|
G (2003) Use of nasal mupirocin for Staphylococcus aureus: effect on nasal carriers and nosocomial infections. Biomedica
|
|
23(2), 173–179 [<a href="https://pubmed.ncbi.nlm.nih.gov/12872556" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12872556</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref22">George
|
|
Susan, Leasure
|
|
A Renee, and Horstmanshof
|
|
Douglas (2016) Effectiveness of Decolonization With Chlorhexidine and Mupirocin in Reducing Surgical Site Infections: A Systematic Review. Dimensions of critical care nursing : DCCN
|
|
35(4), 204–22 [<a href="https://pubmed.ncbi.nlm.nih.gov/27258958" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27258958</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref23">Gernaat-van der Sluis, A J, Hoogenboom-Verdegaal
|
|
A M, Edixhoven
|
|
P J, Spies-van Rooijen, and N H (1998) Prophylactic mupirocin could reduce orthopedic wound infections. 1,044 patients treated with mupirocin compared with 1,260 historical controls. Acta orthopaedica Scandinavica
|
|
69(4), 412–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/9798453" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9798453</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref24">Glotzbecker
|
|
Michael P, Riedel
|
|
Matthew D, Vitale
|
|
Michael G, Matsumoto
|
|
Hiroko, Roye
|
|
David P, Erickson
|
|
Mark, Flynn
|
|
John M, and Saiman
|
|
Lisa (2013) What’s the evidence? Systematic literature review of risk factors and preventive strategies for surgical site infection following pediatric spine surgery. Journal of pediatric orthopedics
|
|
33(5), 479–87 [<a href="https://pubmed.ncbi.nlm.nih.gov/23752143" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23752143</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref25">Harold
|
|
R E, Butler
|
|
B A, Lamplot
|
|
J, Luu
|
|
H H, Lawton
|
|
C D, and Manning
|
|
D (2017) Multifaceted aseptic protocol decreases surgical site infections following hip arthroplasty. Hip Int, 0 [<a href="https://pubmed.ncbi.nlm.nih.gov/28967053" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28967053</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref26">Horiuchi
|
|
Akira, Nakayama
|
|
Yoshiko, Kajiyama
|
|
Masashi, Fujii
|
|
Hideyasu, and Tanaka
|
|
Naoki (2006) Nasopharyngeal decolonization of methicillin-resistant Staphylococcus aureus can reduce PEG peristomal wound infection. The American journal of gastroenterology
|
|
101(2), 274–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/16454830" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16454830</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref27">Hudson
|
|
I R (1994) The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience. The Journal of hospital infection
|
|
27(2), 81–98 [<a href="https://pubmed.ncbi.nlm.nih.gov/7930545" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7930545</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref28">Jabbour
|
|
H, Madi-Jebara
|
|
S, Jabbour
|
|
K, Yazigi
|
|
A, Haddad
|
|
F, Hayek
|
|
G, Yazbeck
|
|
P, and Antakly
|
|
M-C (2010) Does nasal decontamination reduce the incidence of infections after cardiac surgery?. Journal medical libanais
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Jan (2008) Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. The Cochrane database of systematic reviews (4), CD006216 [<a href="/pmc/articles/PMC8988859/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8988859</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18843708" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18843708</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref66">van Rijen, Miranda M L, Bonten
|
|
Marc, Wenzel
|
|
Richard P, and Kluytmans
|
|
Jan A. J. W (2008) Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. The Journal of antimicrobial chemotherapy
|
|
61(2), 254–61 [<a href="https://pubmed.ncbi.nlm.nih.gov/18174201" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18174201</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref67">van Rijen, Miranda Ml, and Kluytmans
|
|
Jan A. J. W (2008) New approaches to prevention of staphylococcal infection in surgery. Current opinion in infectious diseases
|
|
21(4), 380–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/18594290" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18594290</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref68">Verhoeven
|
|
Paul O, Gagnaire
|
|
Julie, Botelho-Nevers
|
|
Elisabeth, Grattard
|
|
Florence, Carricajo
|
|
Anne, Lucht
|
|
Frederic, Pozzetto
|
|
Bruno, and Berthelot
|
|
Philippe (2014) Detection and clinical relevance of Staphylococcus aureus nasal carriage: an update. Expert review of anti-infective therapy
|
|
12(1), 75–89 [<a href="https://pubmed.ncbi.nlm.nih.gov/24308709" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24308709</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref69">Yano
|
|
M, Doki
|
|
Y, Inoue
|
|
M, Tsujinaka
|
|
T, Shiozaki
|
|
H, and Monden
|
|
M (2000) Preoperative intranasal mupirocin ointment significantly reduces postoperative infection with Staphylococcus aureus in patients undergoing upper gastrointestinal surgery. Surgery Today
|
|
30(1), 16–21 [<a href="https://pubmed.ncbi.nlm.nih.gov/10648077" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10648077</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="ch1.appl.ref70">Yu
|
|
M, Mao
|
|
J-Q, Sun
|
|
J-F, and Yuan
|
|
Z-X (2011) Relationship between nasal colonization of Staphylococcus aureus and nosocomial infection after cardiac surgery. Journal of shanghai jiaotong university (medical science)
|
|
31(4), 473–476</div></li></ul></div></div></div><div class="bk_prnt_sctn"><h2>Figures</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="ch1.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20One-way%20sensitivity%20analysis.&p=BOOKS&id=569834_ch1f1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK569834/bin/ch1f1.jpg" alt="Figure 1. One-way sensitivity analysis." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">One-way sensitivity analysis</span></h3></div></div></div><div class="bk_prnt_sctn"><h2>Tables</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="ch1.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO: Does the use of nasal decolonisation to eliminate Staphylococcus aureus (alone or in combination with other interventions) affect the rate of surgical site infection?</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><td headers="hd_b_ch1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">People of any age undergoing any surgery, including minimally invasive surgery (arthroscopic, thoracoscopic and laparoscopic surgery)</td></tr><tr><th id="hd_b_ch1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_ch1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The usage and timing of the following treatments in combination with or without a chlorhexidine body wash or glycopeptide prophylaxis:
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<ul id="ch1.l2"><li id="ch1.lt3" class="half_rhythm"><div>Intranasal mupirocin</div></li><li id="ch1.lt4" class="half_rhythm"><div>Nasal Povidone-Iodine solution</div></li><li id="ch1.lt5" class="half_rhythm"><div>Chlorhexidine nasal gel</div></li><li id="ch1.lt6" class="half_rhythm"><div>Chlorhexidine and neomycin cream (Naseptin)</div></li><li id="ch1.lt7" class="half_rhythm"><div>Octenisan nasal gel</div></li></ul>
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</td></tr><tr><th id="hd_b_ch1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</th><td headers="hd_b_ch1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch1.l3"><li id="ch1.lt8" class="half_rhythm"><div>Placebo</div></li><li id="ch1.lt9" class="half_rhythm"><div>No decolonisation</div></li><li id="ch1.lt10" class="half_rhythm"><div>Different nasal decolonisation procedures</div></li></ul>
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</td></tr><tr><th id="hd_b_ch1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="ch1.l4"><li id="ch1.lt11" class="half_rhythm"><div>Surgical site infections (superficial, deep and organ/space SSI) including MRSA and MSSA SSI defined using appropriate criteria such as CDC SSI criteria. (Including SSIs up to 30 days and 1 year).</div></li><li id="ch1.lt12" class="half_rhythm"><div>Other types of nosocomial infections</div></li><li id="ch1.lt13" class="half_rhythm"><div>Mortality post-surgery</div></li><li id="ch1.lt14" class="half_rhythm"><div>Length of hospital stay</div></li><li id="ch1.lt15" class="half_rhythm"><div>Postoperative antibiotic use</div></li><li id="ch1.lt16" class="half_rhythm"><div>Hospital readmission</div></li><li id="ch1.lt17" class="half_rhythm"><div>Infectious complications such as septicaemia or septic shock</div></li><li id="ch1.lt18" class="half_rhythm"><div>Adverse events:
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<ul id="ch1.l5" class="circle"><li id="ch1.lt19" class="half_rhythm"><div>Antimicrobial resistance</div></li></ul></div></li></ul>
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</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="ch1.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary table of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Short Title</th><th id="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Title</th><th id="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study Details</th><th id="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Intervention</th><th id="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comparator</th><th id="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<a class="bk_pop" href="#ch1.appl.ref1">Bode (2010)</a>
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</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preventing surgical-site infections in nasal carriers of Staphylococcus aureus</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l8"><li id="ch1.lt29" class="half_rhythm"><div>
|
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<b>Study location</b>
|
|
</div><div>Rotterdam, The Netherlands.</div></li><li id="ch1.lt30" class="half_rhythm"><div>
|
|
<b>Study setting</b>
|
|
</div><div>3 university hospitals.</div></li><li id="ch1.lt31" class="half_rhythm"><div>
|
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<b>Study dates</b>
|
|
</div><div>October 2005 to June 2007</div></li><li id="ch1.lt32" class="half_rhythm"><div>
|
|
<b>Duration of follow-up</b>
|
|
</div><div>until 6 weeks after discharge.</div></li><li id="ch1.lt33" class="half_rhythm"><div>
|
|
<b>Sources of funding</b>
|
|
</div><div>Supported by grants from ZonMw, Molnlycke Healthcare, GlaxoSmithKline, Roche, bioMerieux, and 3M</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul id="ch1.l9"><li id="ch1.lt34" class="half_rhythm"><div>2% mupirocin ointment and chlorhexidine body wash</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l10"><li id="ch1.lt35" class="half_rhythm"><div>Placebo (placebo ointment in combination with placebo soap)</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l11"><li id="ch1.lt36" class="half_rhythm"><div>S. aureus SSI</div></li><li id="ch1.lt37" class="half_rhythm"><div>S. aureus superficial SSI</div></li><li id="ch1.lt38" class="half_rhythm"><div>S. aureus deep SSI</div></li><li id="ch1.lt39" class="half_rhythm"><div>S. aureus nosocomial infections</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref2">Kalmeijer (2002)</a>
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|
</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l12"><li id="ch1.lt40" class="half_rhythm"><div>
|
|
<b>Study location</b>
|
|
</div><div>The Netherlands</div></li><li id="ch1.lt41" class="half_rhythm"><div>
|
|
<b>Study setting</b>
|
|
</div><div>Department of Orthopedic Surgery</div></li><li id="ch1.lt42" class="half_rhythm"><div>
|
|
<b>Study dates</b>
|
|
</div><div>January 1997 to July 1999</div></li><li id="ch1.lt43" class="half_rhythm"><div>
|
|
<b>Duration of follow-up</b>
|
|
</div><div>1 month after surgery</div></li><li id="ch1.lt44" class="half_rhythm"><div>
|
|
<b>Sources of funding</b>
|
|
</div><div>Mupirocin ointment and the ingredients for placebo were provided by GlaxoSmithKline.</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l13"><li id="ch1.lt45" class="half_rhythm"><div>2.15% mupirocin ointment</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l14"><li id="ch1.lt46" class="half_rhythm"><div>Placebo nasal ointment</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l15"><li id="ch1.lt47" class="half_rhythm"><div>Overall SSI</div></li><li id="ch1.lt48" class="half_rhythm"><div>Overall superficial SSI</div></li><li id="ch1.lt49" class="half_rhythm"><div>Overall deep SSI</div></li><li id="ch1.lt50" class="half_rhythm"><div>S. aureus SSI</div></li><li id="ch1.lt51" class="half_rhythm"><div>Length of hospital stay</div></li><li id="ch1.lt52" class="half_rhythm"><div>Hospital readmission</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref3">Konvalinka (2006)</a>
|
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</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l16"><li id="ch1.lt53" class="half_rhythm"><div>
|
|
<b>Study location</b>
|
|
</div><div>Ontario, Canada</div></li><li id="ch1.lt54" class="half_rhythm"><div>
|
|
<b>Study setting</b>
|
|
</div><div>Hospital setting</div></li><li id="ch1.lt55" class="half_rhythm"><div>
|
|
<b>Study dates</b>
|
|
</div><div>March 1997 and March 2003.</div></li><li id="ch1.lt56" class="half_rhythm"><div>
|
|
<b>Duration of follow-up</b>
|
|
</div><div>8 weeks</div></li><li id="ch1.lt57" class="half_rhythm"><div>
|
|
<b>Sources of funding</b>
|
|
</div><div>The Cardiovascular Surgery Research Grant and St Michael’s Hospital Foundation Grant.</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l17"><li id="ch1.lt58" class="half_rhythm"><div>2% mupirocin ointment</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l18"><li id="ch1.lt59" class="half_rhythm"><div>Placebo ointment</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l19"><li id="ch1.lt60" class="half_rhythm"><div>Overall SSI</div></li><li id="ch1.lt61" class="half_rhythm"><div>Overall superficial SSI</div></li><li id="ch1.lt62" class="half_rhythm"><div>Overall deep SSI.</div></li><li id="ch1.lt63" class="half_rhythm"><div>S. aureus SSI</div></li><li id="ch1.lt64" class="half_rhythm"><div>Mortality</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref4">Perl (2002)</a>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l20"><li id="ch1.lt65" class="half_rhythm"><div>
|
|
<b>Study location</b>
|
|
</div><div>Iowa, USA</div></li><li id="ch1.lt66" class="half_rhythm"><div>
|
|
<b>Study setting</b>
|
|
</div><div>University of Iowa Hospitals and Clinics and the Veterans Affairs Medical Centre</div></li><li id="ch1.lt67" class="half_rhythm"><div>
|
|
<b>Study dates</b>
|
|
</div><div>April 1995 to December 1998</div></li><li id="ch1.lt68" class="half_rhythm"><div>
|
|
<b>Duration of follow-up</b>
|
|
</div><div>30 days</div></li><li id="ch1.lt69" class="half_rhythm"><div>
|
|
<b>Sources of funding</b>
|
|
</div><div>Research grant from GlaxoSmithKline</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l21"><li id="ch1.lt70" class="half_rhythm"><div>2% mupirocin ointment</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l22"><li id="ch1.lt71" class="half_rhythm"><div>Placebo</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l23"><li id="ch1.lt72" class="half_rhythm"><div>Overall SSI</div></li><li id="ch1.lt73" class="half_rhythm"><div>S. aureus SSI</div></li><li id="ch1.lt74" class="half_rhythm"><div>Overall nosocomial infections</div></li><li id="ch1.lt75" class="half_rhythm"><div>S. aureus nosocomial infections</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref5">Phillips (2014)</a>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preventing surgical site infections: a randomized, open-label trial of nasal mupirocin ointment and nasal povidone-iodine solution</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l24"><li id="ch1.lt76" class="half_rhythm"><div>
|
|
<b>Study location</b>
|
|
</div><div>New York, USA</div></li><li id="ch1.lt77" class="half_rhythm"><div><b>Study setting</b> Not specified</div></li><li id="ch1.lt78" class="half_rhythm"><div>
|
|
<b>Study dates</b>
|
|
</div><div>March 2011 to March 2012</div></li><li id="ch1.lt79" class="half_rhythm"><div>
|
|
<b>Duration of follow-up</b>
|
|
</div><div>3 months</div></li><li id="ch1.lt80" class="half_rhythm"><div>
|
|
<b>Sources of funding</b>
|
|
</div><div>3M Corporation, the manufacturer of the nasal povidone-iodine solution, provided financial support.</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l25"><li id="ch1.lt81" class="half_rhythm"><div>2% mupirocin ointment</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l26"><li id="ch1.lt82" class="half_rhythm"><div>Different nasal decolonisation procedures:</div></li></ul>
|
|
<p>Povidone iodine 5% solution</p>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l27"><li id="ch1.lt83" class="half_rhythm"><div>Overall deep SSI</div></li><li id="ch1.lt84" class="half_rhythm"><div>S. aureus deep SSI</div></li><li id="ch1.lt85" class="half_rhythm"><div>MRSA deep SSI</div></li><li id="ch1.lt86" class="half_rhythm"><div>MSSA deep SSI</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref6">Segers (2006)</a>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l28"><li id="ch1.lt87" class="half_rhythm"><div>
|
|
<b>Study location</b>
|
|
</div><div>Amsterdam, The Netherlands.</div></li><li id="ch1.lt88" class="half_rhythm"><div>
|
|
<b>Study setting</b>
|
|
</div><div>Community Hospital</div></li><li id="ch1.lt89" class="half_rhythm"><div>
|
|
<b>Study dates</b>
|
|
</div><div>August 1st 2003 to September 1st 2005</div></li><li id="ch1.lt90" class="half_rhythm"><div>
|
|
<b>Duration of follow-up</b>
|
|
</div><div>30 days</div></li><li id="ch1.lt91" class="half_rhythm"><div>
|
|
<b>Sources of funding</b>
|
|
</div><div>No funding. All materials were provided by the local hospital pharmacy.</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l29"><li id="ch1.lt92" class="half_rhythm"><div>0.12% chlorhexidine gluconate solution</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l30"><li id="ch1.lt93" class="half_rhythm"><div>Placebo</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l31"><li id="ch1.lt94" class="half_rhythm"><div>Overall SSI</div></li><li id="ch1.lt95" class="half_rhythm"><div>Overall deep SSI</div></li><li id="ch1.lt96" class="half_rhythm"><div>S. aureus SSI</div></li><li id="ch1.lt97" class="half_rhythm"><div>Overall nosocomial infections</div></li><li id="ch1.lt98" class="half_rhythm"><div>Nosocomial infection: Lower respiratory tract infection</div></li><li id="ch1.lt99" class="half_rhythm"><div>Nosocomial infection: Urinary tract infection</div></li><li id="ch1.lt100" class="half_rhythm"><div>Nosocomial infection: Bacteraemia</div></li><li id="ch1.lt101" class="half_rhythm"><div>30-day mortality post-surgery</div></li><li id="ch1.lt102" class="half_rhythm"><div>Length of hospital stay</div></li><li id="ch1.lt103" class="half_rhythm"><div>Hospital readmission</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref7">Sousa (2016)</a>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preoperative Staphylococcus aureus Screening/Decolonization Protocol Before Total Joint Arthroplasty-Results of a Small Prospective Randomized Trial</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l32"><li id="ch1.lt104" class="half_rhythm"><div>
|
|
<b>Study location</b>
|
|
</div><div>Portugal</div></li><li id="ch1.lt105" class="half_rhythm"><div>
|
|
<b>Study setting</b>
|
|
</div><div>Department of Orthopaedics</div></li><li id="ch1.lt106" class="half_rhythm"><div>
|
|
<b>Study dates</b>
|
|
</div><div>January 2010 and December 2012</div></li><li id="ch1.lt107" class="half_rhythm"><div>
|
|
<b>Duration of follow-up</b>
|
|
</div><div>1 year after surgery.</div></li><li id="ch1.lt108" class="half_rhythm"><div>
|
|
<b>Sources of funding</b>
|
|
</div><div>Not specified</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l33"><li id="ch1.lt109" class="half_rhythm"><div>2% mupirocin ointment and chlorhexidine body wash</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l34"><li id="ch1.lt110" class="half_rhythm"><div>No treatment (no nasal decolonisation or body wash)</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l35"><li id="ch1.lt111" class="half_rhythm"><div>Overall deep SSI</div></li><li id="ch1.lt112" class="half_rhythm"><div>S. aureus deep SSI</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref8">Suzuki (2003)</a>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l36"><li id="ch1.lt113" class="half_rhythm"><div>
|
|
<b>Study location</b>
|
|
</div><div>Japan</div></li><li id="ch1.lt114" class="half_rhythm"><div>
|
|
<b>Study setting</b>
|
|
</div><div>University hospital</div></li><li id="ch1.lt115" class="half_rhythm"><div>
|
|
<b>Study dates</b>
|
|
</div><div>June 1998 and December 2000</div></li><li id="ch1.lt116" class="half_rhythm"><div>
|
|
<b>Duration of follow-up</b>
|
|
</div><div>30 days</div></li><li id="ch1.lt117" class="half_rhythm"><div>
|
|
<b>Sources of funding</b>
|
|
</div><div>Not reported</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l37"><li id="ch1.lt118" class="half_rhythm"><div>2% mupirocin ointment</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l38"><li id="ch1.lt119" class="half_rhythm"><div>No nasal decolonisation</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l39"><li id="ch1.lt120" class="half_rhythm"><div>Overall SSI</div></li><li id="ch1.lt121" class="half_rhythm"><div>Overall superficial SSI</div></li><li id="ch1.lt122" class="half_rhythm"><div>Overall deep SSI</div></li><li id="ch1.lt123" class="half_rhythm"><div>S. aureus SSI</div></li><li id="ch1.lt124" class="half_rhythm"><div>Overall nosocomial infections</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_ch1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bk_pop" href="#ch1.appl.ref9">Tai (2013)</a>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nasal carriage of Staphylococcus aureus in patients undergoing Mohs micrographic surgery is an important risk factor for postoperative surgical site infection: a prospective randomised study</td><td headers="hd_h_ch1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l40"><li id="ch1.lt125" class="half_rhythm"><div class="half_rhythm">
|
|
<b>Study location</b>
|
|
</div><div class="half_rhythm">Australia</div></li><li id="ch1.lt126" class="half_rhythm"><div class="half_rhythm">
|
|
<b>Study setting</b>
|
|
</div><div class="half_rhythm">Surgery and Dermatology Centre.</div></li><li id="ch1.lt127" class="half_rhythm"><div class="half_rhythm">
|
|
<b>Study dates</b>
|
|
</div><div class="half_rhythm">1st April to 31st October 2011</div></li><li id="ch1.lt128" class="half_rhythm"><div class="half_rhythm">
|
|
<b>Duration of follow-up</b>
|
|
</div><div class="half_rhythm">All patients were followed up in the postoperative period for signs of clinical infection. Duration is not specified.</div></li><li id="ch1.lt129" class="half_rhythm"><div class="half_rhythm">
|
|
<b>Sources of funding</b>
|
|
</div><div class="half_rhythm">Not specified.</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l41"><li id="ch1.lt130" class="half_rhythm"><div>2% mupirocin ointment and chlorhexidine body wash</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l42"><li id="ch1.lt131" class="half_rhythm"><div>No treatment (no nasal decolonisation or body wash)</div></li></ul>
|
|
</td><td headers="hd_h_ch1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="ch1.l43"><li id="ch1.lt132" class="half_rhythm"><div>S. aureus SSI</div></li><li id="ch1.lt133" class="half_rhythm"><div>MRSA SSI</div></li><li id="ch1.lt134" class="half_rhythm"><div>MSSA SSI</div></li></ul>
|
|
</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="ch1.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Base case cost-effectiveness model results</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK569834/table/ch1.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch1.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Strategy</th><th id="hd_h_ch1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Total cost</th><th id="hd_h_ch1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Total QALYs</th><th id="hd_h_ch1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_ch1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental QALYs</th><th id="hd_h_ch1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICER</th></tr></thead><tbody><tr><td headers="hd_h_ch1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Universal mupirocin</td><td headers="hd_h_ch1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£43</td><td headers="hd_h_ch1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.9233</td><td headers="hd_h_ch1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mupirocin if screened positive</td><td headers="hd_h_ch1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£55</td><td headers="hd_h_ch1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.9232</td><td headers="hd_h_ch1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£12</td><td headers="hd_h_ch1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">−0.0001</td><td headers="hd_h_ch1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dominated by universal mupirocin</td></tr><tr><td headers="hd_h_ch1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Standard care only</td><td headers="hd_h_ch1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£56</td><td headers="hd_h_ch1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.9229</td><td headers="hd_h_ch1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£13</td><td headers="hd_h_ch1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">−0.0003</td><td headers="hd_h_ch1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dominated by universal mupirocin</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">Key: ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year.</p></div></dd></dl></div></div></div></div></div><div><p>Guideline version (FINAL)</p></div><div><p>These evidence reviews were developed by NICE Guideline Updates Team</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK569834</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/33905189" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">33905189</a></span></div></div></div>
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