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MSSA and MRSA pre-operative showering protocols for THR/TKR found effective

Josephine

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MSSA and MRSA decolonization protocols for TJA found effective
Chen A. J Arthroplasty. 2013;doi:10.1016/j.arth.2013.03.036. July 26, 2013 LINK

Protocols for preoperative decolonization of methicillin-resistant Staphylococcus aureus and methicillin-sensitive S. aureus, such as the use of intranasal mupirocin and chlorhexidine washes, are effective and helped prevent surgical site infection in patients who underwent total joint arthroplasty, according to this study.

“The results of our study demonstrate that utilizing a current decolonization protocol significantly reduces the colonization of [methicillin-sensitive S. aureus] MSSA/[methicillin-resistant S. aureus] MRSA in nasal carriers. Three of the patients who were positive for MSSA preoperatively and underwent decolonization were persistently positive on the day of surgery,” Antonia F. Chen, MD, MBA, and colleagues wrote in the study. “One patient who was positive was not compliant with the decolonization protocol, so it was expected that she would be MSSA positive at the time of surgery.”

The patients showered daily using chlorhexidine body wash and used intranasal mupirocin twice daily starting 5 days pre-operatively. Preoperative nasal swabs showed 22% of joints were MSSA positive and 5% tested MRSA positive. At surgery, 2.8% of decolonized joints still showed MSSA colonization, but no joints were positive for MRSA, according to the abstract.

“The positive day of surgery S. aureus colonization and the negative pre-operative screen for the SSI [surgical site infection] patient is most likely due to the fact that the pre-operative swabs were not sensitive enough to detect S. aureus colonization,” Chen and colleagues wrote. “Studies have shown that nares swabs may only detect 54% of S. aureus using the culture swabs described above, but it is location of highest colonization.”
 

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