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Updated: May 14, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden
Sapna Mehta1, Scott Hadley, Lorraine Hutzler
1Department of Infection Control, NYU Langone Medical Center, New York, NY 10009, USA.
Background:
Hospital-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a source of morbidity and mortality. S. aureus is the most common pathogen in prosthetic joint infections and the incidence of MRSA is increasing.
Questions/Purposes:
The purposes of this study were (1) to determine the MRSA prevalence density rate at a specialty orthopaedic hospital before and after the implementation of a screening and decolonization protocol,(2) to compare our prevalence density to that of an affiliated university hospital, to control for changes in MRSA prevalence density that might have been independent of the decolonization protocol, and (3) to measure the admission prevalence density rate of MRSA in an elective orthopaedic surgery population and the compliance rate of 26 patients with the protocol [corrected].
Methods:
In October 2008, we implemented a MRSA screening and decolonization protocol for patients undergoing elective orthopaedic surgery. Nasal swabs were used for screening and mupirocin nasal ointment and chlorhexidine skin antisepsis where prescribed for decolonization to all patients. At the surgical visit, compliance was measured and the patients who were MRSA positive received vancomycin for antibiotic prophylaxis. Institution wide surveillance for multidrug-resistant organisms, including MRSA provided a comparison of the change in MRSA burden at the orthopaedic hospital versus the university hospital.
Results:
Before implementation of the preoperative staphylococcal decolonization protocol there were 79 MRSA-positive cultures in 64,327 patient-days for a prevalence density rate of 1.23 per 1000 patient-days. After protocol implementation, 53 MRSA-positive cultures were identified in 63,860 patient-days for a rate of 0.83 per 1000 patient-days. Before the protocol, the MRSA prevalence density at the specialty hospital was similar to that of the university hospital; after implementation of the protocol, the prevalence density at the specialty hospital was 33% lower than that of the university hospital. The MRSA admission prevalence was 3.02%. The compliance rate was greater than 95%.
Conclusions:
Implementation of a staphylococcal decolonization protocol at a single specialty orthopaedic hospital decreased the prevalence density of MRSA.
Insights
A new screening and decolonization protocol significantly reduced methicillin-resistant Staphylococcus aureus (MRSA) rates in an orthopedic hospital. This initiative lowered MRSA prevalence density by 33% compared to a university hospital.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Hospital Epidemiology
Background:
- Hospital-acquired infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA), contribute significantly to patient morbidity and mortality.
- Staphylococcus aureus is a leading cause of prosthetic joint infections, with a concerning rise in MRSA incidence.
Purpose of the Study:
- To assess the impact of a screening and decolonization protocol on MRSA prevalence density in an orthopedic hospital.
- To compare MRSA prevalence density changes with an affiliated university hospital to isolate protocol effects.
- To determine the admission prevalence of MRSA in elective orthopedic surgery patients and protocol compliance.
Main Methods:
- Implementation of a MRSA screening and decolonization protocol using nasal swabs, mupirocin, and chlorhexidine for elective orthopedic surgery patients.
- Monitoring MRSA prevalence density pre- and post-protocol, alongside institution-wide surveillance for comparison.
- Assessing patient compliance with the protocol and vancomycin use for MRSA-positive patients.
Main Results:
- MRSA prevalence density decreased from 1.23 to 0.83 per 1000 patient-days after protocol implementation.
- The orthopedic hospital's MRSA prevalence density was 33% lower than the university hospital's post-protocol.
- Admission MRSA prevalence was 3.02% with a compliance rate exceeding 95%.
Conclusions:
- A targeted staphylococcal decolonization protocol effectively reduced MRSA prevalence density in a specialized orthopedic setting.
- The findings support the implementation of such protocols to mitigate MRSA burden in high-risk surgical populations.
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