Intraoperative Risk Factors

MRSA and MSSA Preoperative Screening & Decolonization

Incidence of infection with staphylococcal and non-staphylococcal bacteria has been shown to decrease with preoperative screening for Methicillin-Resistant Staphylococcus aureus species (MRSA) and Methicillin-Susceptible Staphylococcus Aureus (MSSA) species along with decolonization methods. Despite confirmed and adequate treatment of MRSA carriers. There is a risk of SSI.

Surgeon Tools/Recommendations:

  • Screen for Staphylococcus aureus (MRSA and MSSA) preoperatively for procedures, especially arthroplasty procedures.
  • Intranasal mupirocin is a topical antimicrobial that has been shown to significantly decrease bacterial burden in 85% of those who complete a course of treatment
  • Patient compliance is a concern with the use of mupirocin as it requires the patient to apply the topical solution to their nares 3 times a day for 5 days.

Decolonization Methods (MRSA and MSSA)

  • Short-term nasal application of mupirocin prior to joint replacement surgery (3 times a day for 5 days).
  • Recent studies demonstrate support for universal decolonization protocols without screening for patients undergoing a total joint arthroplasty procedure, especially in high-risk patients.