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Institutional Prescreening for Detection and Eradication of Methicillin-Resistant Staphylococcus aureus in Patients Undergoing Elective Orthopaedic Surgery
David H. Kim, MD1; Maureen Spencer, RN1; Susan M. Davidson, MD1; Ling Li, MSPH1; Jeremy D. Shaw, BA2; Diane Gulczynski, RN1; David J. Hunter, MD, PhD1; Juli F. Martha, MPH1; Gerald B. Miley, MD1; Stephen J. Parazin, MD1; Pamela Dejoie1; John C. Richmond, MD1
1 Department of Orthopaedic Surgery (D.H.K., M.S., D.G., S.J.P., P.D., and J.C.R.); Division of Infectious Disease, Department of Medicine (S.M.D. and G.B.M.); Division of Research (L.L., D.J.H., and J.F.M.); New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120. E-mail address for D.H. Kim:dhkim@caregroup.harvard.edu
2 Case Western Reserve University School of Medicine, Euclid Avenue, Cleveland OH 44106
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 (DePuy-Mitek, Stryker, LifeNet, Serica, and Axial Biotech) and less than $10,000 (DePuy and Allen Medical) or a commitment or agreement to provide such benefits from a commercial entity.

A commentary by Bassam A. Masri, MD, FRCSC, is available at www.jbjs.org/commentary and as supplemental material to the online version of this article.
Investigation performed at New England Baptist Hospital, Boston, Massachusetts

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Aug 04;92(9):1820-1826. doi: 10.2106/JBJS.I.01050
A commentary by Bassam A. Masri, MD, FRCSC, is available here
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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.

Level of Evidence: 

Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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