title: Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Screening and Decolonization to Reduce Surgical Site Infection in Elective Total Joint Arthroplasty.
abstract: Deep infection after elective total joint arthroplasty remains a devastating complication. Preoperative nasal swab screening for Staphylococcus aureus colonization and subsequent treatment of colonized patients is one proposed method to identify at-risk patients and decrease surgical site infections (SSIs). The purpose of this study was to determine whether a preoperative staphylococcus screening and treatment program would decrease the incidence of SSI in elective joint arthroplasty patients.
  
  
  
  Since January 2009, a total of 9690 patients having an elective joint arthroplasty were screened before surgery for Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) with nares swabs. All patients with positive nare colonization for MSSA and MRSA were treated with mupirocin and chlorhexidine gluconate showers for 5 days before surgery. MRSA patients received vancomycin preoperatively and were placed in contact isolation. All elective arthroplasty patients used chlorhexidine gluconate antiseptic cloths the evening prior and the day of surgery. Perioperative infection rates were compared from 1 year before implementation to 5 years after implementation of this screening protocol.
  
  
  
  SSI rates have decreased from 1.11% (prescreening) to 0.34% (nasal screening; P < .05) after initiation of the process. Staphylococcus was identified in 66.7% of the SSI infections before nasal screening and in 33.3% of the SSI after routine screening (P > .05).
  
  
  
  The addition of MRSA and/or MSSA nares screening along with a perioperative decolonization protocol has resulted in a decreased SSI rate by 69%.
authors.affiliation: Department of Orthopaedic Surgery, Northwestern Medicine Central DuPage Hospital, Winfield, IL; Department of Orthopaedic Surgery, RUSH University Medical Center, Chicago, IL.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sporer
authors.affiliation: Department of Orthopaedic Surgery, Northwestern Medicine Central DuPage Hospital, Winfield, IL.
authors.forename: Thea
authors.initials: T
authors.lastname: Rogers
authors.affiliation: Department of Orthopaedic Surgery, Northwestern Medicine Central DuPage Hospital, Winfield, IL.
authors.forename: Linda
authors.initials: L
authors.lastname: Abella
mesh_terms: D000281:Administration, Intranasal; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001178:Arthroplasty; D019643:Arthroplasty, Replacement; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008712:Methicillin; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D016712:Mupirocin / Q000627:therapeutic use*; D009296:Nasal Cavity / Q000382:microbiology; D011300:Preoperative Care; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000891:Anti-Infective Agents, Local; D014640:Vancomycin; D016712:Mupirocin; C010882:chlorhexidine gluconate; D008712:Methicillin; D002710:Chlorhexidine
keywords: arthroplasty; complication; infection; nasal screening; staphylococcus; surgical site