MRSA Carrier Screening and Decolonization Before Surgery

Join this channel to support the channel https://www.youtube.com/channel/UCOHfqHMhHvfQCYJDXfpSAiw/join Tests that orthopedic surgeons should consider include MRSA screening and decolonization. An important question is: Is this patient a MRSA carrier? Should we screen this patient for MRSA? A strategy for preventing surgical site infection includes optimizing the patient before surgery. The patient should be nutritionally fit. Issues such as smoking, diabetes, and obesity should be addressed. In addition, the condition of the skin and soft tissues at the planned surgical incision site should be optimized. Another important factor is reducing the bacterial burden carried by the patient. Immediately before surgery, prophylactic preoperative antibiotics are administered, and efforts are made to decrease contamination in the operating room. Approximately eighty percent of the organisms that cause infections are brought to the operating room by the patients themselves. These organisms may include methicillin-sensitive Staphylococcus aureus or methicillin-resistant Staphylococcus aureus, meaning MSSA or MRSA carriers. If these carriers are identified and treated before hospital admission, the infection rate can be reduced. Once patients are admitted to the hospital, bacteria can spread from one patient to another, which is why proper hand hygiene and effective handwashing are extremely important. How can we reduce the bacterial burden that patients carry? Since patients bring these bacteria to the hospital and the operating room, screening in the clinic or office becomes important. Screening for MSSA or MRSA can be performed, followed by decolonization. Some patients have large bacterial reservoirs and are considered carriers. These patients have a higher risk of surgical site infection. Common reservoirs include the nose, axilla, groin, and perianal area. Identifying these carriers and eradicating the bacteria can reduce the risk of surgical site infection. Being a carrier significantly increases the risk of infection. The risk of surgical site infection is approximately ten times higher if the patient is an MRSA carrier. Patients often do not know they are carriers unless they are tested. Identifying MRSA carriers allows the use of appropriate antibiotics such as vancomycin when necessary. A carrier is an individual who can spread bacteria without necessarily becoming ill. Approximately two percent of the population are MRSA carriers. MRSA is a contagious bacterium and is difficult to treat because it is resistant to many commonly used antibiotics. The resistance mechanism involves the bacterial cell wall. Normally, penicillin binds to a penicillin-binding protein in the bacterial cell wall, disrupting the cell wall and killing the bacteria. However, when Staphylococcus aureus acquires the mecA gene, the penicillin-binding protein becomes altered. This altered protein prevents penicillin and related antibiotics from binding, resulting in resistance to all penicillins. Many individuals carry MRSA without symptoms and are unaware of it. Transmission usually occurs through direct contact with another person, contact with contaminated objects, or respiratory droplets from an infected individual. Approximately thirty percent of Staphylococcus bacteria reside in the nose. Overall, twenty-five to thirty percent of the population are colonized with Staphylococcus, meaning the bacteria are present but not causing infection. The odds of infection increase about sixfold if a patient is an MSSA carrier and about tenfold if the patient is an MRSA carrier. MRSA carriers are usually identified by nasal swab culture. Identifying these patients before hospital admission allows eradication of the organisms through a decolonization protocol. This typically includes two to four percent chlorhexidine body washes for five days. The chlorhexidine should remain on the skin surface for a prolonged period because it is more effective when not washed off immediately. In addition, two percent nasal mupirocin ointment is applied twice daily for five days. Mupirocin is a topical antibiotic used inside the nose to eliminate colonization. Screening and eradication programs can reduce infection rates by approximately forty to sixty percent or more, depending on patient compliance. Some institutions have found that empiric treatment may be less costly than universal screening. In certain total joint arthroplasty programs, preoperative empiric mupirocin treatment is given to all patients. Studies from these institutions show that empiric treatment may reduce costs compared with routine screening and decolonization protocols. In addition, empiric treatment may improve workflow efficiency without compromising patient care.