494. Sustained reduction in MRSA surgical site infections (SSI) following Cardiothoracic (CT) Surgery
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Staph aureus, including MRSA, accounts for >50% of SSI after CT surgery, and carries significant morbidity. RGH performs ~900 CT cases annually, and MRSA causes 54% of SSI during 2004-2006. On 2/1/07 a comprehensive MRSA control program was instituted on the CT service.
Methods: The program included (1) pre-operative MRSA screening with IV Vancomycin added to standard Cefazolin prophylaxis for positive patients, (2) nasal mupirocin ointment administration one day prior to and 4 days after surgery for all patients regardless of screen results, (3) mupirocin application to chest tube sites upon removal post-operatively, (4) all patients were rescreened for MRSA at discharge. The occurrence of SSI was monitored by active and passive surveillance, defined according to CDC criteria. The incidence of MRSA SSI for the baseline period (1/1/04 - 1/31/07) was compared to the intervention period (2/1/07-4/31/09).
Results: There were 59 SSI following 2766 (2.3 % incidence) CT cases during the baseline period; of these 32 were MRSA for an incidence of 1.2%. During the intervention period, 1.6% of patients were colonized with MRSA pre-operatively; all were negative at discharge. Six patients acquired MRSA colonization post-operatively. Two of 2030 (0.1%) CT cases during the intervention period developed MRSA SSI (both deep sternal), a reduction of 92 % (P < .0001) from baseline; no MRSA infections have occurred in the last 15 months. The overall rate of SSI fell from 2.3% to 0.7% (p = .0001); the decrease in SSI due to other organisms was not significant (p = .15), and there was no change in the incidence of hospital wide MRSA SSI or bacteremia during the intervention period.
Conclusion: An MRSA control program of preoperative screening, but directed at eliminating MRSA acquisition post-operatively in all patients using intranasal mupirocin can diminish MRSA SSI substantially, and be sustained for up to 27 months.
Linda Greene, RN1, Ronald Kirshner, MD1, Edward Walsh, MD, FIDSA2 and  E. E. Walsh,
Astra Zeneca Role(s): Consultant, Consultant, Consultant, Received: Consulting Fee.
L. Greene, None..
R. Kirshner, None., (1)Rochester General Hospital, Rochester, NY, (2)University of Rochester School of Medicine and Den, Rochester, NY

Disclosures:

L. Greene, None

R. Kirshner, None

E. Walsh, None