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Archive March 2018 XIX, No. 3

How We Implemented MRSA Screening

By targeting our most vulnerable patients, we dramatically reduced SSIs.

Roberta Schofield

Roberta Schofield, MSN, APRN, PCNS-BC, CNOR


Clean Nose
KEEP YOUR NOSE CLEAN It takes only 3 seconds to swirl a swab inside a patient's nose, but that simple step could dramatically reduce surgical-site infections in your patients. Nasal bacteria are a primary component in the spread of infection.

Implementing a comprehensive Surgical Site Infection (SSI) bundle that includes screening your most vulnerable patients for Methicillin-resistant Staphylococcus aureus (MRSA) takes planning, patience and perseverance. We achieved 100% SSI bundle compliance within 3 months of implementation and reached our goal by reducing our SSI rate from 2.9% to 1.2%. Here's how we did it.

More than CHG

As part of our SSI bundle, we provide patients at Nemours/ Alfred I. duPont Hospital for Children with chlorhexidine gluconate (CHG) cloths. In 2016, we implemented additional items into our SSI bundle for our implant patients. For these patients, in addition to our standard bundle elements, we added a MRSA screening protocol and a nasal betadine swab.

Implant patients have a greater risk of developing SSIs. When a patient with an implant develops an SSI, she might have to have the implant removed and replaced, which prolongs hospitalization. While an SSI has a financial impact no matter the case, the cost is significantly higher with implant recipients. Additional costs of an SSI in these patients can range upwards of $25,000 to $30,000.

While the MRSA screening initiative focuses on the implant patients, the process can be easily adapted to all patients if the need arises.

Once we decided to move forward with the MRSA screening process, the challenges were significant and sometimes surprising. We do about 1000 surgeries a month. Of those, about 100 are implant patients.

To move this new screening process forward, we needed to engage and educate every nurse, surgeon and anesthesiologist. As a clinical nurse specialist in perioperative services, I collaborated with our physician leadership to attend all the division meetings. The entire team needed to understand what the bundle was and the implication of the practice change. If there was an orthopedics meeting at 6 in the morning, we were there. If there was a general surgery meeting at 6 in the evening, we made sure to go. For our nurses, we rolled out web-based training for the entire staff and did in-services on all the nursing units.

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