• Screen and treat. One of the key parts of MRSA prevention proto-
cols is screening for those infected or carrying the pathogen and
decolonizing those who are, says Kevin T. Kavanagh, MD, MS, FACS, a
healthcare policy researcher and patient safety advocate based in
Lexington, Ky. "Some providers think this protocol should only be
applied to certain patient groups — those undergoing joint replace-
ments, for example — but by performing this surveillance on all
patients, you are much more likely to prevent the spread of MRSA in
your facility."
Patients are tested for the presence of pathogenic bacteria in the
nasal cavity with a simple culture or with rapid molecular testing. A
culture will help to reduce the cost of the surveillance process, but it
takes several days to get results, says Dr. Kavanagh. Patients who are
infected with MRSA or are carriers of the pathogen should undergo
decolonization. This involves using an intranasal antibiotic, often
mupirocin, 2 to 3 times daily. Most decolonization protocols also
require daily bathing with an antiseptic solution for 5 days. MRSA
positive patients should have at least one negative culture before
undergoing surgery.
Screening and treating must be done well in advance of surgery, so
get your surgeons invested in the process, suggests Dr. Kavanagh.
"Make it part of your facility's written protocol that all patients who
are scheduled to undergo surgery must be tested before the day of
surgery," he adds. "Ideally, this can be done at pre-op visits to sur-
geons' offices."
There are several reasons to avoid treating all patients as if they
have MRSA, says Dr. Kavanagh. First, the type of prophylactic
antibiotic given will vary depending upon the MRSA carrier's
state. Second, intranasal antibiotics, along with certain antisep-
tics, can promote bacterial resistance in the targeted pathogen
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