op with prophylaxis povidone-iodine as a precautionary measure.
Lori Groven, MSPHN, RN, CIC, an infection preventionist at TRIA
Orthopaedic Center in Bloomington, Minn., helped implement a
screening program in response to an uptick in S. aureus infection
among total joint patients. Screening patients for S. aureus demands
constant communication between your facility and surgeons' sched-
ulers and support staff, says Ms. Groven. Who will check daily screen-
ing results? Who will contact patients who test positive? Who's
responsible for ordering medications for patients who test positive?
Ms. Groven, who says about 15% of TRIA's patients are carriers of S.
aureus, suggests you place orders for pre-op screenings as soon as
patients are scheduled for surgery and put your infection prevention-
ist in charge of making sure patients are compliant with the order and
receive antibiotics as needed. She also suggests creating an Excel
spreadsheet to track the screening results of every patient scheduled
for surgery.
"Check it daily to ensure patients who do test positive receive treat-
ment," says Ms. Groven. "Assure patients that their surgery won't be
cancelled — as long as you have enough lead time to treat them."
2. Administer antibiotics. On the day of surgery, give MRSA-posi-
tive patients vancomycin and MRSA-negative patients cefazolin as
part of the antibiotic protocol. Keep in mind that the timing of antibi-
otic administration is critical in joint replacement patients.
"We found that anesthesia providers weren't always administering
antibiotics as intended, which is before tourniquet placement on the
operative extremity," says Ms. Yerkes.
Vancomycin takes 60 minutes to fully infuse, she explains, and must
be totally infused before the tourniquet cuts off circulation around the
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