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Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients

Smith, Harvey, MD, FACD; Borchard, Kate, MBBS, FACD; Cherian, Paul, MBBS, FACD; Tai, Yee, MBBS, FACD; Vinciullo, Carl, MBBS, FACD*

doi: 10.1097/DSS.0000000000001662
Original Article

BACKGROUND Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus).

OBJECTIVE The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus.

METHODS AND MATERIALS The authors performed a randomized controlled trial of S. aureus nasal swab–negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention.

RESULTS In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29).

CONCLUSION Topical decolonization reduces SSI in nasal swab–negative Mohs surgery patients.

*All authors are affiliated with Oxford Dermatology, Perth, Western Australia, Australia

Address correspondence and reprint requests to: Harvey Smith, MD, FACD, Oxford Dermatology, First Floor Suite 4A, 416-418 Oxford Street, Mount Hawthorn, Perth 6016, Western Australia, or e-mail:

The study was partly funded by a grant from the Australasian College of Dermatologists.

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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