She didn't know a whole lot
about Methicillin resistant
Staphylococcal aureus (MRSA)
and nasal decolonization. She
learned fast that:
• 80% of wound infections are
traced to the patients' own
nasal flora;
• most patients who develop
MRSA infection will have been
colonized before infection;
• 30% of people are colonized
with Staphylococcus aureus, the leading cause of surgical site infec-
tions (SSI), when they reach the OR; and
• you can reduce MRSA SSIs through nasal decolonization.
Treat all or screen and treat?
Despite the VA's best efforts to reduce infections, SSI rates among vet-
erans had been on the rise, Ms. Schmidt discovered. A few things
struck her when she examined the VA's old protocol. One to 4 weeks
before surgery, cardiac and orthopedic patients were screened for
MRSA colonization via nasal swab. Patients who were MRSA-positive
were treated with mupirocin ointment to the nares and chlorhexidine
showers. At least that was the plan.
But physicians and patients alike struggled to comply with the
mupirocin protocol. Patients weren't always screened more than 7
days before surgery, some surgeons operated on patients with positive
screens who hadn't yet been decolonized and patients didn't always
follow instructions — not surprising when you consider that they had
A U G U S T 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 3 1
Since they started swabbing
the nares of every patient
with povidone iodine
2 hours before surgery,
they've had 0 SSIs. Bonus:
It only takes 2 minutes for
a pre-op nurse (or the
patient) to swab and the
PI costs $14 per patient.
