title: Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery.
abstract: BACKGROUND
  Surgical site infection has been identified as one of the most important preventable sources of morbidity and mortality associated with medical treatment. The purpose of the present study was to evaluate the feasibility and efficacy of an institutional prescreening program for the preoperative detection and eradication of both methicillin-resistant and methicillin-sensitive Staphylococcus aureus in patients undergoing elective orthopaedic surgery.
  
  
  METHODS
  Data were collected prospectively during a single-center study. A universal prescreening program, employing rapid polymerase chain reaction analysis of nasal swabs followed by an eradication protocol of intranasal mupirocin and chlorhexidine showers for identified carriers, was implemented. Surgical site infection rates were calculated and compared with a historical control period immediately preceding the start of the screening program.
  
  
  RESULTS
  During the study period, 7019 of 7338 patients underwent preoperative screening before elective surgery, for a successful screening rate of 95.7%. One thousand five hundred and eighty-eight (22.6%) of the patients were identified as Staphylococcus aureus carriers, and 309 (4.4%) were identified as methicillin-resistant Staphylococcus aureus carriers. A significantly higher rate of surgical site infection was observed among methicillin-resistant Staphylococcus aureus carriers (0.97%; three of 309) compared with noncarriers (0.14%; seven of 5122) (p = 0.0162). Although a higher rate of surgical site infection was also observed among methicillin-sensitive Staphylococcus aureus carriers (0.19%; three of 1588) compared with noncarriers, this difference did not achieve significance (p = 0.709). Overall, thirteen cases of surgical site infection were identified during the study period, for an institutional infection rate of 0.19%. This rate was significantly lower than that observed during the control period (0.45%; twenty-four cases of surgical site infection among 5293 patients) (p = 0.0093).
  
  
  CONCLUSIONS
  Implementation of an institution-wide prescreening program for the identification and eradication of methicillin-resistant and methicillin-sensitive Staphylococcus aureus carrier status among patients undergoing elective orthopaedic surgery is feasible and can lead to significant reductions in postoperative rates of surgical site infection.
  
  
  METHODS
  Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA. dhkim@caregroup.harvard.edu
authors.forename: David H
authors.initials: DH
authors.lastname: Kim
authors.forename: Maureen
authors.initials: M
authors.lastname: Spencer
authors.forename: Susan M
authors.initials: SM
authors.lastname: Davidson
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Shaw
authors.forename: Diane
authors.initials: D
authors.lastname: Gulczynski
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter
authors.forename: Juli F
authors.initials: JF
authors.lastname: Martha
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Miley
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Parazin
authors.forename: Pamela
authors.initials: P
authors.lastname: Dejoie
authors.forename: John C
authors.initials: JC
authors.lastname: Richmond
mesh_terms: D000281:Administration, Intranasal; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D002353:Carrier State / Q000175:diagnosis / Q000382:microbiology; D002437:Cefazolin / Q000008:administration & dosage; D002710:Chlorhexidine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus; D008826:Microbial Sensitivity Tests; D016712:Mupirocin / Q000008:administration & dosage; D009296:Nasal Cavity / Q000382:microbiology; D009824:Ointments; D009985:Orthopedics; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D009824:Ointments; D014640:Vancomycin; D016712:Mupirocin; D002437:Cefazolin; D002710:Chlorhexidine