1674. Variable Screening and Decolonization Protocols for Staphylococcus aureus Carriage before Surgery
Session: Poster Abstract Session: Surgical Site Infections (SSI)
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
  • SA.screening.IDWeek.2012.poster_v3.final pdf.pdf (1.5 MB)
  • Background: Staphylococcus aureus (SA) causes 20% of surgical site infections (SSI) in the U.S. . SA carriage prior to surgery increases the risk of post-operative SA SSI. Because, healthcare providers are currently uncertain about the benefits and cost-effectiveness of pre-operative screening and decolonization of SA carriage, we assessed the current SA screening and decolonization practices prior to surgery cross various healthcare institutions and settings.

    Methods: We used Survey Monkey to solicit responses to a standardized questionnaire and queried members of the Minnesota APIC, 314 members, including long term care facilities, the SHEA Research Network (RN), 179 members, who represent 207 institutions and the Minnesota Hospital Association (MHA), 145 members.

    Results: Among the queried members of SHEA RN, MN APIC and the MHA, we received 131 responses to our survey; response rate 131/638 (20.5%): 62/131 (47.3%) from MN. Altogether, 26 states and 13 countries were represented by the SHEA RN.

    Figure  SEQ Figure \* ARABIC 1: Types of institutions that responded to our survey (x axis).    (No. of these institutions is on the y axis.)

    49/131 respondents, (37.4%) screen for SA before operations; most commonly before orthopedic and cardiovascular procedures. Of these 49, 41% had state mandated SA screening policies, but only 12% mandated screening before surgery. Of the 49 respondents who perform pre-operative screening, 19 (38.7%) screen for Methicillin-sensitive SA (MSSA) before surgery, and 45 (91.8%) screen for Methicillin-resistant SA (MRSA) before surgery. 91% will isolate patients if they find MRSA, only 5% isolate patients with MSSA. The most common screening sites include nares and throat. Most decolonize MSSA (89.5%) and a smaller proportion decolonizes MRSA (75.6%). The common decolonization methods include nasal mupirocin and chlorhexidine gluconate bathing soap. Institutions rarely use oral antibiotic therapy to decolonize patients colonized with SA.

    Conclusion: Screening and decolonization practices vary significantly among surgeons and healthcare institutions. Institutions may not focus on all S. aureus but just MRSA.  While the sample size is small and Minnesota is relatively heterogeneous, our data suggest that there are knowledge deficits that can be addressed to improve prevention strategies.

    Susan Kline, MD, MPH, Medicine /ID Division, University of Minnesota Medical School, Minneapolis, MN, Tram Pham, Medical Student, University of Minnesota Medical School, Minneapolis, MN and Trish M. Perl, MD, MSc, FIDSA, FSHEA, Johns Hopkins Medical Institutions, Baltimore, MD


    S. Kline, None

    T. Pham, None

    T. M. Perl, Merck: Grant Investigator, Research grant
    Hospira: Board Member, Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.