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

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.