On the flip side,
some facilities may
not be cautious
enough. They do noth-
ing with respect to
identifying high-risk
patients. Surgeons
may order pre-op
bathing for patients,
but skin preps have
little or no effect on
nasal passages, which
is the key area of concern for MRSA.
Fortunately, new products that are both highly effective and rela-
tively inexpensive are emerging.
It's easy to see why MRSA makes some facilities nervous. A 2009
study identified it as the leading cause of surgical site infections in
community hospitals. Traditionally, the best option has been to cul-
ture patients who were considered high-risk by using nasal swabs. If
results came back positive, a decolonization program could then be
implemented. That usually meant giving patients a chlorhexidine glu-
conate (CHG) wash and writing a prescription for topical mupirocin,
an antibiotic that's applied to the anterior nares, in an attempt to
decolonize before surgery.
The nasal passages are the key, because while several areas of the
body can carry MRSA organisms — including the axillae, groin, phar-
ynx and gastrointestinal tract — the anterior nares tend to be head-
quarters. That's where Staphylococcus aureus is thought to hide from
host defenses. When the nares are treated, MRSA tends to disappear
from other areas of the body, as well.
5 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U N E 2 0 1 7
• NO HIDING ATP testing will be increasingly useful now that new guidelines call for cleaning-
verification testing on endoscopes.
