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3-Minute Turnover - Outpatient Surgery Magazine - December 2018

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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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- 6 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 8

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