197652 A countywide targeted surveillance/decolonization project in select orthopedic patients utilizing PCR to detect MRSA

Tuesday, November 10, 2009

Jeanne A. Linquist, MD , Disease Control and Prevention, San Mateo County Health Department, San Mateo, CA
Bruce K. Fujikawa, PhD , Director Public Health Laboratory, San Mateo County Health Department, San Mateo, CA
Scott Morrow, MD, MPH , Health Officer, San Mateo County Health System, San Mateo, CA
Background: The importance of MRSA as a significant pathogen has implications for research, therapy, epidemiology, and economics. Studies show the relationship between staphylococcal nasal colonization and surgical site infections, and also suggest that pre-operative intranasal mupirocin can eliminate colonization and decrease deep infection in patients undergoing specific types of cardiac or orthopedic surgery. Laboratory data submitted over ten years to San Mateo County Health Department showed an increase in MRSA from 10% of staphylococcal isolates to 60%. We utilized the concept of Public Health Practice to evaluate MRSA in orthopedic patients scheduled to undergo total joint arthroplasty (TJA) in San Mateo County at any of six hospitals associated with four different healthcare systems. Objective: objectives were to (1)determine by a prospective observational study the MRSA nasal colonization rate in patients scheduled for TJA (2)make available to surgeons a surveillance/decolonization program, documenting their acceptance. Methods: Packets were prepared for each orthopedist followed by recruitment and in-office education. Nasal specimens obtained from the patients at their pre-operative evaluation were sent by courier directly to the Public Health Laboratory. Results were faxed to the surgeons' offices within 24 hours, allowing pre-operative decolonization. Results: 14 orthopedic practices were eligible to participate; two declined for an 86% acceptance rate. Another later declined. 36 surgeons in 11 practices continued the program. Sampling occurred from 7/9/07 - 7/9/08. 17/383 specimens (4.4%) were positive for MRSA. Conclusions: Objectives were met.

Learning Objectives:
Identify nasal carriage rate of MRSA in patients scheduled for total joint replacement. Design a project for decolonization of such patients that was acceptable to the surgeons

Keywords: Infectious Diseases, Community Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: MD (Baylor U. Houston Texas) Fellowship in Infectious Diseases (U. of Iowa)Medical Director Infection Control Mills-Peninsula Hospital (Sutter Health) consultant in ID (adult) and Consulting Health Officer San Mateo County working on control of resistant staphyloccal infections.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.