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MRSA screening for surgical site infection prevention prior to hysterectomy at a cancer center

MRSA screening for surgical site infection prevention prior to hysterectomy at a cancer center content piece image
Objectives: Screening and decolonization for methicillin resistant staphylococcus aureus (MRSA) is routinely performed prior to surgery in many centers, however limited data describe the contribution of MRSA to surgical site infections (SSIs) in gynecologic oncology patients. We present the outcome of a MRSA screening and decolonization program implemented as part of a bundled
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