Document Detail

Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden.
MedLine Citation:
PMID:  23423618     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hospital-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a source of morbidity and mortality. S. aureus is the most common pathogen in prosthetic joint infections and the incidence of MRSA is increasing.
QUESTIONS/PURPOSES: The purposes of this study were (1) to determine the MRSA prevalence density rate at a specialty orthopaedic hospital before and after the implementation of a screening and decolonization protocol,(2) to compare our prevalence density to that of an affiliated university hospital, to control for changes in MRSA prevalence density that might have been independent of the decolonization protocol, and (3) to measure the admission prevalence density rate of MRSA in an elective orthopaedic surgery population and the compliance rate of 26 patients with the protocol [corrected].
METHODS: In October 2008, we implemented a MRSA screening and decolonization protocol for patients undergoing elective orthopaedic surgery. Nasal swabs were used for screening and mupirocin nasal ointment and chlorhexidine skin antisepsis where prescribed for decolonization to all patients. At the surgical visit, compliance was measured and the patients who were MRSA positive received vancomycin for antibiotic prophylaxis. Institution wide surveillance for multidrug-resistant organisms, including MRSA provided a comparison of the change in MRSA burden at the orthopaedic hospital versus the university hospital.
RESULTS: Before implementation of the preoperative staphylococcal decolonization protocol there were 79 MRSA-positive cultures in 64,327 patient-days for a prevalence density rate of 1.23 per 1000 patient-days. After protocol implementation, 53 MRSA-positive cultures were identified in 63,860 patient-days for a rate of 0.83 per 1000 patient-days. Before the protocol, the MRSA prevalence density at the specialty hospital was similar to that of the university hospital; after implementation of the protocol, the prevalence density at the specialty hospital was 33% lower than that of the university hospital. The MRSA admission prevalence was 3.02%. The compliance rate was greater than 95%.
CONCLUSIONS: Implementation of a staphylococcal decolonization protocol at a single specialty orthopaedic hospital decreased the prevalence density of MRSA.
Sapna Mehta; Scott Hadley; Lorraine Hutzler; James Slover; Michael Phillips; Joseph A Bosco
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article     Date:  2013-02-20
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-10     Completed Date:  2013-08-28     Revised Date:  2014-07-01    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2367-71     Citation Subset:  AIM; IM    
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MeSH Terms
Anti-Bacterial Agents / administration & dosage
Anti-Infective Agents, Local / administration & dosage
Antibiotic Prophylaxis
Chi-Square Distribution
Chlorhexidine / administration & dosage
Community-Acquired Infections / diagnosis,  drug therapy*,  epidemiology,  microbiology,  transmission
Cross Infection / diagnosis,  epidemiology,  microbiology,  prevention & control*,  transmission
Hospitals, University
Infection Control / methods*
Mass Screening*
Medication Adherence
Methicillin-Resistant Staphylococcus aureus / isolation & purification*
Mupirocin / administration & dosage
Nasal Mucosa / microbiology
Orthopedic Procedures / adverse effects*
Patient Admission
Program Evaluation
Staphylococcal Infections / diagnosis,  drug therapy*,  epidemiology,  microbiology,  prevention & control*,  transmission
Surgical Procedures, Elective
Time Factors
Treatment Outcome
Vancomycin / administration & dosage
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Anti-Infective Agents, Local; 6Q205EH1VU/Vancomycin; D0GX863OA5/Mupirocin; R4KO0DY52L/Chlorhexidine
Comment In:
Clin Orthop Relat Res. 2013 Jul;471(7):2372-3   [PMID:  23690147 ]
Erratum In:
Clin Orthop Relat Res. 2013 Jun;471(6):2044

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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