Authors: Sittana S. Elshafie, Philippe Landreau, Nebojsa Popovic.
Background: Methicillin resistant Staphylococcus aureus (MRSA), Methicillin resistant Staphylococcus epidermidis (MRSE) and Methicillin sensitive Staphylococcus aureus (MSSA) carriage is an independent risk factor for orthopedic surgical site infection (SSI). To determine whether a preoperative screening and decolonization protocols reduces MSSA, MRSA, and MRSE SSIs, we conducted a comparison of SSIs rate in the prescreening period with the post screening period of patients undergoing arthroscopic orthopedic surgery.
Methods: Patients in the post screening period were screened initially for MRSA and MRSE by collecting nasal, axillary and surgical site swabs. One month after the start of screening and decolonization we experienced one patient with MSSA SSI. Since then MSSA was also included in the screening protocol starting end of October 2009. Carriers were decolonized with mupirocin nasal ointment 3 times daily for 5 days, and chlorhexidine bath once
daily for 5 days before surgery.
Results: During the study period 1108 patients under went preoperative screening. Among these 8 (0.7%) of patients were identified as MRSA carriers, 315 (28%) MRSE carriers and 206 (18%) were MSSA carriers. Overall 9 cases of SSIs were identified, 8 cases before screening, and one case after screening for MRSA and MRSE and no SSI were diagnosed after MSSA screening was added.
Discussion and Conclusion: Orthopedic SSIs is disabling and associated with increased cost. They prolong total hospital stay and double readmission rate. Patients with orthopedic SSIs have substantially greater physical limitation and significant reduction in their quality of life. We conclude the implementation of a preoperative screening protocol for the identification and eradication of MRSA, MRSE and MSSA carriage and decolonization of patients undergoing orthopedic surgery is feasible and can lead to a significant reduction in surgical site infection.
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