A U G U S T 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 3 3
As the number of total joint procedures
performed each year increases, so will the
risk of infection. Let's review the clinical
reasoning behind key ways to prevent bac-
teria from colonizing surgical wounds.
• MRSA decolonization. Staphylococcus
aureus is one of the most common
pathogens associated with orthopedic SSIs.
Targeted screening involves identifying
patients felt to be at risk for MRSA coloniza-
tion (history of antibiotic use within the past 3
months, hospitalization within the past 12 months), screening with
nasal swabs and treatment of confirmed carriers with mupirocin oint-
ment applied to the nares 2 to 3 times a day for 5 days, with or without
concomitant bathing with chlorhexidine gluconate (CHG). More
recently, reports of rising rates of resistance to mupirocin have
prompted exploration of other agents such as povidone iodine or
ethanol for nasal decolonization.
You can opt instead to universally treat all patients either with a pre-
surgery home regimen (5 days of mupirocin and/or CHG bathing) or a
nasal application of an ethanol antiseptic or povidone-iodine applica-
tion immediately before surgery. Proponents of universal decoloniza-
tion point to the many studies demonstrating a reduction in SSIs.
Opponents cite the resources needed to implement such a program
and the potential for unnecessary treatment of non-carriers.
• Pre-op bathing. The rationale behind preoperative patient
bathing is a simple one: reduce the bacterial load on the skin prior to
Exploring the 'Why' of Infection Prevention
RATIONALE REVIEW
• SURE SHOT Prophylactic antibiotics
should be administered 1 to 2 hours
before incision time to reduce the bacte-
ria load at the surgical site.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
