Decolonization of MRSA Investigating the effect of a decolonization protocol on post operative total joint replacement patients' MRSA infections

Sallie Chapman, Gardner-Webb University


Methicillin-resistant Staphylococcus aureus (MRSA) is a growing concern in health care organizations as well as within the community. As the rates of MRSA continue to rise, there have been efforts to attempt to reduce these infections in surgical patients by decolonization treatment. There are many recommendations for decolonization treatment in surgical patients, but there has been limited research in total joint patients to determine the impact of screening and subsequent decolonization treatment in the prevention of MRSA surgical site infections. The purpose of this study is to investigate the relationship of a screening and decolonization program and MRSA surgical site infection rates.

The Human Motion Institute of Orthopaedics, at Gaston Memorial Hospital, in Piedmont North Carolina, implemented a screening protocol in January 2008, to observe total joint patients who are colonized with MRSA. Patients with a positive culture for MRSA colonization are decolonized with chlorhexidine gluconate 4% wash and mupirocin 2% ointment preoperatively. This study of 1,316 patients utilized retrospective data to determine the infection rates of total joint patients who had their surgery prior to protocol implementation (n=544), as well as patients having a total joint replacement following protocol implementation (n=759). The infection rates were compared to determine the relationship between decolonized patients and patients not being screened and decolonized for MRSA preoperatively.

Results indicated an infection rate of 0.7% prior to the implementation of the protocol and 0.8% after implementation of the protocol. Although this study does not demonstrate a significant improvement in infection rate, the findings discussed in this study demonstrate the benefits of a decolonization program and contribute to evidence based nursing practice.