Outpatient Surgery Magazine

Special Outpatient Surgery Edition - Infection Control - May 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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• 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 4 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 • M A y 2 0 1 8

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