Project Name: Perioperative Eradication of Staph aureus
Project Aim: To eradicate perioperative colonization with Staph aureus in order to reduce the risk of surgical site infections for patients undergoing elective total joint procedures.
Time Frame: May 2009 - ongoing
Background:
Surgical site infections (SSI) are an infrequent but serious complication of total joint arthroplasty with rates around 1.5 %. Orthopaedic surgical site infections cause substantial morbidity, prolong hospital stay, lead to readmission and increase healthcare costs. Carriers of Staph aureus are two to nine times more likely to acquire Staph aureus surgical site infections than non carriers. Thus, interventions designed to eradicate nasal carriage preoperatively will decrease surgical site infections.
Description:
RRMC and Vermont Orthopaedic Clinic have implemented a program to eradicate Staph aureus colonization in patients undergoing elective total joint procedures (hips, knees and shoulders) as well as certain spine procedures. This is the first eradication program of its kind in the State of Vermont. The process is managed during the perioperative period by the surgeon, pre-op nurses and infection control.
The methods used are adapted from New England Baptist Hospital (NEBH) in Boston who performs over 6000 orthopaedic procedures each year. Following implementation, NEBH reported 78% eradication of MRSA prior to surgery and demonstrated a 50% reduction in surgical site infections due to Staph aureus.
The method we use includes preoperative identification of staph aureus and MRSA by nasal swab and culture. Patients with Methicillin Sensitive Staph aureus (MSSA) carriage receive a five day treatment course of Mupirocin and standard preoperative prophylaxis. Patients with Methicillin Resistant Staph aureus (MRSA) carriage receive a five day treatment course of mupirocin and preoperative prophylaxis with Vancomycin or an agent with activity against MRSA. All patients are instructed to bath once a day for 5 days prior to surgery with chlorhexidine.
The surgical site infection rate for orthopaedic clean cases at Rutland Regional Medical Center is low. On average, our clean case infection rate is 0.6% which is lower than the 1-2% comparative rate. This project is part of our commitment to work toward zero infections.
Measures:
% of Patients Undergoing Elective Joint Replacement with MRSA colonization
% of Patients Undergoing Elective Joint Replacement with MSSA colonization
% of Preoperative eradication of MRSA colonization
Orthopaedic Clean Case Surgical Site infection rate
Results:
Early results of our project are depicted below. To date we have screened 174 patients. Two percent of patients screened were colonized with MRSA and fifteen percent were colonized with MSSA. MRSA eradication was successful in two patients. Further testing is pending in two cases. All patients will be monitored for surgical site infections for one year post implant.
 
Contact information:
Denise Simpson, MT(ASCP), CIC, CPHQ
Director of Performance Improvement
e-mail: dsimpson@rrmc.org
Reference:
Maureen Spencer, RN, MEd, CIC, Diane Gulcyznski, RN, MS, CNOR, Susan Davidson, MD, John Richmond, MD, New England Baptist Hospital, Boston, Mass. Abstract 118 “Eradication of Methicillin Sensitive Staphylococcus aureus and Methicillin Resistnat Staphylococcus aureus Before Orthopedic Surgery.” 18th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (SHEA), April 5-8, 2008.
Nalini Rao MD, FACP, PSHEA, Barbara Cannella RN, Lawrence S. Crossett MD, A.J. Yates Jr MD, Richard McGough III MD. "A Preoperative Decolonization Protocol for Staphylosoccus aureus Prevents Orthopaedic Infections." Clin Orthop Relat Res (2008): 1343-1348.
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