Poster No. 6
Title:
Eradication of Methicillin Sensitive Staphylococcus aureus and Methicillin Resistant Staphylococcus aureus
Before Orthopaedic Surgery
Authors:
Maureen Spencer, Susan Davidson, Diane Gulczynski, Susan Cohen, Stephen Parazin, John Richmond
Presented by:
Maureen Spencer
Departments:
Infection Control Unit, Department of Infectious Disease, Department of Patient Care Services, Department of
Orthopedics and Rehabilitative Services, New England Baptist Hospital
Abstract:
Introduction: Asymptomatic colonization with Methicillin-resistant Staphylococcus aureus (MRSA) and
Methicillin-sensitive Staphylococcus aureus (MSSA) has been described in the literature as a risk factor for
orthopaedic surgical site infection (SSI). Identifying Staphylococcus aureus colonization in the pre-surgical
screening process is important in reducing SSI. We examined the effectiveness of preoperative surveillance and
eradication on colonization rates in orthopaedic SSI.
Methods:
We performed preoperative anterior nares surveillance screens of 7.019 patients admitted for
orthopaedic surgery using polymerase chain reaction (PCR) assay. The treatment intervention for MRSA and
Staph aureus patients was a 5-day application of intranasal mupirocin 2% applied twice daily. MRSA positive
patients were instructed to bathe with chlorhexidine for 5 days and were rescreened prior to surgery. Contact
precautions were implemented if the second screen was positive for MRSA. All MRSA positives received
Vancomycin for surgical prophylaxis.
Results: From July 17, 2006 through March 31, 2009, 16,486 patients were screened; 3,957 (23%) were Staph
aureus positive and 710 (4%) were MRSA positive. Repeat nasal screens were obtained from MRSA patients
prior to surgery and revealed 77% eradication. In the cohort of positive screens, there were 7/3,957 Staph aureus
infections (0.18%) and 9/710 MRSA infections (1.28%). In the 11,819 negative screens there were 11 (0.09%)
infections (3 MRSA and 8 MSSA). Overall, there were 27 SSI in 16,458 screened patients (0.16%). In an
equivalent group of historical controls during the prior year, there were 24 MRSA/MSSA infections in 5,283
cases (0.45%).
Conclusions: We have documented a significant reduction in orthopaedic SSI with the implementation of a
MSSA/MRSA surveillance and eradication program for all inpatient surgeries during the preoperative screening
process.
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