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Archive Infection Control 2018

Stop the Spread of MRSA

Nasal decolonization is a practical way to lower infection risks.

Kendal Gapinski

Kendal Gapinski, Contributing Editor


Nasal Injection
NO ONE NOSE Swabbing the nasal cavity immediately before patients enter the OR could be one part of a multifaceted preventative plan.

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causes of surgical site infections, but many facilities don't identify and treat carriers. With more complex procedures moving to the outpatient arena, it's critical that you prevent the spread of MRSA by applying topical antibiotics or antiseptics to the noses of patients before they step foot in your ORs.

• Screen and treat. One of the key parts of MRSA prevention protocols is screening for those infected or carrying the pathogen and decolonizing those who are, says Kevin T. Kavanagh, MD, MS, FACS, a healthcare policy researcher and patient safety advocate based in Lexington, Ky. "Some providers think this protocol should only be applied to certain patient groups — those undergoing joint replacements, for example — but by performing this surveillance on all patients, you are much more likely to prevent the spread of MRSA in your facility."

Patients are tested for the presence of pathogenic bacteria in the nasal cavity with a simple culture or with rapid molecular testing. A culture will help to reduce the cost of the surveillance process, but it takes several days to get results, says Dr. Kavanagh. Patients who are infected with MRSA or are carriers of the pathogen should undergo decolonization. This involves using an intranasal antibiotic, often mupirocin, 2 to 3 times daily.

Most decolonization protocols also require daily bathing with an antiseptic solution for 5 days. MRSA positive patients should have at least one negative culture before undergoing surgery.

Screening and treating must be done well in advance of surgery, so get your surgeons invested in the process, suggests Dr. Kavanagh. "Make it part of your facility's written protocol that all patients who are scheduled to undergo surgery must be tested before the day of surgery," he adds. "Ideally, this can be done at pre-op visits to surgeons' offices."

There are several reasons to avoid treating all patients as if they have MRSA, says Dr. Kavanagh. First, the type of prophylactic antibiotic given will vary depending upon the MRSA carrier's state. Second, intranasal antibiotics, along with certain antiseptics, can promote bacterial resistance in the targeted pathogen and other organisms. Unnecessary antibiotics also impact the patient's microbiome. Though it's added work, it's truly best to first test the patient and treat only when necessary.

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