Reducing postoperative MRSA infection in joint replacement patients: results of pre-operative active surveillance for MRSA

Background: Infections occurring post-operatively in patients having joint replacement can pose major challenges for treatment. Infections caused by MRSA can be devastating often resulting in impaired joint functioning and/or loss of the prosthesis and death. Historically the incidence of post surgical infection in our joint replacement patients has been low but MRSA has been the causative organism in several cases.

Objective: Reduce the risk of MRSA infection in joint replacement patients using active surveillance.  Methods: Patients scheduled for joint replacement are swabbed unless previously identified as colonized with MRSA. Staff  inform the patient’s surgeon and Infection Prevention of positive lab results. The record is flagged. Surgery is scheduled for an end of day time slot. On admission, Contact Precautions are implemented. The pre-operative antibiotic is changed. Vancomycin 15 mg/kg is given 30 minutes in addition to cefazolin, the standard  prophylaxis. A second dose is given 12 hours later. For patients with abnormal kidney function the dose is adjusted to their creatinine clearance.
Results: From Jan. 2005 through Dec. 2007, 3224 surgeries were performed. Of these 17 patients developed a postoperative infection, 5 of which cultured positive for MRSA.  In 2008, after implementation of active surveillance, 5 infections from 1684 surgeries were identified. None were MRSA positive.

Conclusions: Active MRSA surveillance allows for early identification of colonized patients. Adjustment of their pre-operative antibiotic prophylaxis helps eliminate MRSA at the incision site and prevents surgical infections.