2. Screen for colonization
A patient who is MRSA-positive has a 30% to 60% increased risk of devel-
oping an SSI and needs to be treated with antibiotics before undergoing
surgery. Patients are typically screened to determine if they are carriers
several weeks before surgery and given topical mupirocin prophylaxis,
which effectively eradicates Staph aureus in the nasal carriage. Patients
who test positive for MRSA should have their surgical prophylaxis
changed to vancomycin.
There's been a growing trend in surgical facilities to do away with
screening and treating patients because it's labor intensive and expen-
sive (it costs about $120 for the screening and antibiotic treatments). I
think that's a mistake. Surgeons need to know they're operating on
MRSA patients and adjust the surgical prophylaxis.
Research is underway to show that nasal decolonization with alco-
hol- or povidone-iodine-based nasal antiseptic products are just as
effective as mupirocin in nasal prophylaxis. When studies show the
topical applications are effective options, mupirocin should no longer
be used for universal nasal decolonization.
3. Prep the skin
Bathing with 4% chlorhexidine gluconate (CHG) liquid soap or 2%
CHG-impregnated wipes hasn't been proven to reduce SSIs, but it's an
important element of a broader risk-reduction strategy. Research has
shown that CHG skin-prepping products require 2 applications to
attain maximum antimicrobial benefit, so patients should apply 4
ounces of CHG liquid soap the night before and morning of surgery,
and let it sit on the skin around the surgical site for 60 seconds before
rinsing it off. For wipes, patients should apply 3 wipes the night
before surgery and 3 wipes the morning of the procedure.
The removal of skin contaminants, oil and residual microorgan-
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