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Preoperative MRSA screening using a simple questionnaire prior elective total joint replacement
Fidelius Von Rehlingen-Prinz1,2, Michael Röhrs1, Nemandra Sandiford1
1Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany.
Introduction:
The purpose of this study was to evaluate the management and results of our standarized protocol for preoperative identification of MRSA colonisation in patients undergoing primary total hip and knee replacement procedures.
Methods:
Following hospital protocol, between January 2016 and June 2019 37,745 patients awaiting elective joint replacement underwent a standardized questionnaire to assess the risk of MRSA infection, identifying patients requiring preoperative MRSA screening. An evaluation of the questionnaire identified effective questions for identifying infected patients. Furthermore, an analysis evaluated the impact of comorbidities or Charlson Comorbidity Index scores on positive MRSA colonization. Additionally, we evaluated the cost savings of targeted testing compared to testing all surgery patients.
Results:
Of the 37,745 patients, 8.057 (21.3%) were swabbed, with a total of 65 (0.81%) positive tests. From this group 27 (36.48%) who were treated were negative before surgery. Some of the questionnaire results were consistently associated with a higher chance of colonization, including hospitalization during the past year (47,7%), previous history of MRSA (44,6%), and agriculture or cattle farming related work (15,4%). By selectively testing high-risk patients identified through the questionnaire, we achieved a 79% reduction in costs compared to universal MRSA screening.
Conclusion:
Our results suggest that the simple and standardized questionnaire is a valuable tool for preoperative screening, effectively identifying high-risk patients prone to MRSA colonisation. The risk of periprosthetic joint infection (PJI) and its associated sequelae may be reduced by this approach.
Insights
A standardized questionnaire effectively identifies patients at high risk for MRSA colonization before joint replacement surgery. This targeted screening reduces costs and may lower the risk of periprosthetic joint infection.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) colonization poses a risk for surgical site infections, particularly in joint replacement procedures.
- Standardized protocols for preoperative identification of MRSA colonization are crucial for patient management.
- Evaluating the effectiveness and cost-efficiency of screening methods is essential.
Purpose of the Study:
- To assess a standardized protocol for preoperative MRSA colonization identification in patients undergoing hip and knee replacements.
- To evaluate the efficacy of a risk-assessment questionnaire in identifying high-risk patients for MRSA screening.
- To analyze the cost savings associated with targeted MRSA testing versus universal screening.
Main Methods:
- A cohort of 37,745 patients awaiting elective joint replacement were assessed using a standardized questionnaire.
- Questionnaire data was analyzed to identify effective questions for MRSA risk stratification.
- The impact of comorbidities and Charlson Comorbidity Index on MRSA colonization was evaluated.
- Cost analysis compared targeted testing with universal screening.
Main Results:
- Of 37,745 patients, 8,057 (21.3%) were screened, with 65 (0.81%) testing positive for MRSA.
- Key indicators for MRSA colonization included recent hospitalization (47.7%) and prior MRSA history (44.6%).
- Targeted testing resulted in a 79% cost reduction compared to universal screening.
Conclusions:
- A simple, standardized questionnaire is a valuable tool for preoperative MRSA screening.
- The questionnaire effectively identifies high-risk patients for MRSA colonization.
- This targeted approach may reduce the incidence of periprosthetic joint infection and related complications.
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