MRSA Suppression Protocol for Total Joint Surgeries

In December, 2006 IOS began screening all total joint patients for MRSA prior to surgery. What is MRSA and why are we doing this?

• MRSA is a staphylococcus bacteria that is resistant to beta-lactam antibiotics, such as Methicillin, oxacillin, penicillin and amoxicillin. 25-30% of the population is colonized with staph with approximately 1% colonized with MRSA. MRSA is a growing concern in healthcare and can be hospital acquired or community acquired.
• Colonization refers to the presence of bacteria in or on a host with growth and multiplication, but not tissue invasion or damage, no symptoms other than a positive culture. Colonization can lead to infection.
• Screening is done by nasal and rectal swab. If positive, the patient is given treatment to decolonize 24 hours before surgery. This is done to lessen the possibility of the surgical patient later developing a wound infection, but colonization may persist in spite of treatment. For this reason, the patient is placed in contact isolation until discharge.
• Preventing the spread is by judicious use of antibiotics, appropriate barrier precautions (contact isolation), and rigorous hand hygiene.