3 6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J A N U A R Y 2 0 1 7
you're hosting and your facility's history of infection," says Phenelle Segal, RN,
CIC, president of Infection Control Consulting Services in Delray Beach, Fla.
Patients who are likely carriers come from long-term care facilities, have history
of Methicillin-resistant Staphylococcus aureus (MRSA) infection or have been
recently hospitalized, says Ms. Segal.
The evidence doesn't support screening for patients undergoing eye surgery,
for example, but you can cost-justify testing patients if you host orthopedic and
spine cases, which typically involve high-risk patients.
The direct financial costs of treating surgical site infections, as well as the
associated risks of morbidity and mortality, have increased the awareness and
use of pre-op screening for multidrug-resistant organisms, says Ms. Segal. "We're
seeing a lot more screening done in the outpatient setting as surgeons and care-
givers are beginning to understand the financial burden surgical site infections
place on facilities and patients."
Ms. Segal points out that screening isn't a significant expense and companies
have introduced screening kits with rapid turnaround times. "If a facility feels
that the risk assessment of a patient indicates an increased risk of surgical site
infection, and the surgery type justifies screening, they should test the patient,
because they can decolonize positive patients before surgery," she says.
Immediate-result screenings aren't yet available. Swabbing must occur at least
5 days before surgery, because that's how long treatment with the nasal decolo-
nizing agent mupirocin takes to complete, says Ms. Segal.
• Screen everyone. Antonia Chen, MD, MBA, a joint replacement specialist at
the Rothman Institute in Philadelphia, screens every patient scheduled to under-
go primary or revision hip and knee replacements for S. aureus with the hope
of reducing the risk of post-op infection.
Dr. Chen says joint replacement patients undergoing revision surgery, who are
a high-risk population, comprise 30 to 40% of her joint replacement cases.
Patients undergoing primary replacements are less likely than revision patients
to carry S. aureus, but are still at heightened risk. Dr. Chan says 20 to 30% of
