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Implementation of a pre-operative decolonization protocol of Methicillin Resistance Staphylococcus
aureus in elective orthopedic surgery at Manatí Medical Center: Pilot Study.

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of S. aureus that
shows resistance to multiple antibiotics. Up to 30% of S. aureus strains isolated
from nosocomial infections are MRSA, and it has become a growing problem
for public health. The cost of MRSA infection is also having a huge impact
financially and results in considerable resource utilization. Puerto Rico’s
Legislature passed Law # 298 on October 19, 2012 for the control and prevention
of MRSA infections in medical installations in Puerto Rico. In order to comply
with the law we conducted a pilot study to identify possible setbacks of the
implementation of the MRSA decolonization protocol as standard of care therapy in
our institution while contributing to the process of quality improvement and
patient safety. Nasal swabs were taken at the Pre-admission Department and
processed through a PCR-based MRSA detection assay. A protocol of decolonization
in patients with positive results was implemented. The study showed
that patients without apparent risk factors could be colonized either with
MRSA or Methicillin-sensitive S. aureus (MSSA). The time between pre-
admission and surgery was less than the indicated for a proper decolonization
procedure. Therefore, 50% of the scheduled surgeries could have been
postponed in case of positive MRSA or MSSA. In our experience patient’s education
was crucial to guarantee compliance and adherence to treatment. In
order to decrease risk of wound infection we recommend that both, screening
process and decolonization if required, be performed before the preadmission
appointment for elective surgery. This study provided a framework for MRSA
pre-admission screening and decolonization in our Institution.