title: Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors: Department of Infection Control, NYU Langone Medical Center, New York, NY 10009, USA.
authors: Sapna
authors: S
authors: Mehta
authors: Scott
authors: S
authors: Hadley
authors: Lorraine
authors: L
authors: Hutzler
authors: James
authors: J
authors: Slover
authors: Michael
authors: M
authors: Phillips
authors: Joseph A
authors: JA
authors: Bosco
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D002710:Chlorhexidine / Q000008:administration & dosage; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D017558:Elective Surgical Procedures; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008403:Mass Screening; D055118:Medication Adherence; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D016712:Mupirocin / Q000008:administration & dosage; D009297:Nasal Mucosa / Q000382:microbiology; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010343:Patient Admission; D015995:Prevalence; D015397:Program Evaluation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D014640:Vancomycin; D016712:Mupirocin; D002710:Chlorhexidine