MRSA screening for surgical site infection prevention prior to hysterectomy at a cancer center
intervention to prevent SSIs after hysterectomy at a cancer center.
Methods: Patients were screened for MRSA colonization by polymerase chain reaction nasal swab during their preoperative surgical consultation. Decolonization of MRSA carriers included oral doxycycline 100 mg twice daily for 7 days, and mupirocin 2% ointment to both nares for 5 days. For all MRSA carriers, vancomycin was added to routine preoperative antibiotics. We implemented a perioperative SSI prevention bundle on July 19, 2016 which included a renewed in-service teaching for clinic staff to increase performance of MRSA screening. Additional interventions included preoperative 4% chlorhexidine gluconate (CHG) showers, the use of 4% CHG topical wipes on day of surgery, revised and standardized preoperative antibiotics, a 4% CHG soap vaginal prep, and post-op 4% CHG showers. Consecutive patients undergoing hysterectomy by the gynecologic oncology division 6 months PRE and POST implementation of the bundled intervention were retrospectively reviewed. Statistical analysis included Fishers exact test and the Kruskal-Wallis test.
Results: From 1/18/2016 to 1/18/2017 we identified 358 women undergoing hysterectomy (178 PRE-intervention and 180 POST-intervention). MRSA screening was completed in 129/178 (72.5%) PRE, and 159/180(88.3%) POST (p<0.001). MRSA colonization was detected in 10/298 (3.4%), with 4/129 (3.1%) PRE and 6/159 (3.8%) POST intervention (p=1.0). Decolonization was completed in 2/4 PRE and 5/6 POST patients. The SSI rate was 14/178 (7.9%) PRE and 6/180 (3.3%) POST. Cultures were collected for 13/14 PRE and 6/6 POST SSIs. At least one organism was identified in 5/6 PRE and 10/13 POST. No SSIs involved MRSA.
Conclusions: Preoperative MRSA screening is feasible for the gynecologic oncology population. Screening rates can be improved with in-service teaching. MRSA is an uncommon cause of SSI after hysterectomy. Cost effectiveness of MRSA screening prior to hysterectomy should be evaluated