1. MRSA Screen Before the Knife.
Clinical Problem
In the United States it is not common practice to screen for Methicillin-Resistant Stapholococcus Areus (MRSA) prior to surgery. However, hospital-acquired and community acquired MRSA incidences are rising.
Research suggests nasal MRSA is associated with post-operation infections of MRSA and poor outcomes. Patients that obtain MRSA infections require longer hospital stays, higher healthcare costs for the individual and the hospital, more likely for readmission within 90 days, and have a higher mortality rate.
It is estimated that the number of older adults undergoing surgery will increase from 40 million in 2010 to 71 million by As the number of surgical patients increase, most likely the amount of surgical site infections will grow as well. MRSA is the most common cause of surgical site infections.
Clinical Question
For surgical patients does the use of MRSA screenings on admission and proper protection equipment reduce the risk of MRSA infections compared to those who are not screened?
Literature Review Process
CINAHL Plus with Full Text was utilized to research if MRSA screening is necessary for surgical patients. Key terms such as “MRSA screening,” “personal protection equipment,” “surgical patients,” and “post-op MRSA infections” were used.
The search results were limited to articles and journals published in the past five years. Only peer reviewed literature which met the criteria for this clinical problem was considered for this project.
The criteria included the effectiveness of pre-surgical MRSA screenings and the effectiveness of proper personal protective equipment. After analyzing numerous sources, four peer reviewed journal articles and one surgical nursing article were utilized and reviewed.
Synthesis of the Literature
The findings from the literature collectively supports the need for pre-surgical
MRSA screenings to reduce hospital acquired infections and poor patient
outcomes. The data also reinforces the necessity of wearing personal
protective equipment when in contact with MRSA patients.
By performing nasal swabs prior to surgery, patients that have nasal MRSA
colonization can receive prophylactic antibiotics as well as proper contact
precautions to prevent hospital-acquired MRSA infections throughout the unit.
Results of a randomized controlled trial found that by performing nasal swabs
before surgery, the use of PPE, and chlorhexidine wipes reduced the
prevalence of hospital-acquired MRSA by 63%.
A Monte Carlo decision-analysis computer simulation study created to find
the cost benefits of pre-operational nasal swabs for cardiac surgical patients
found there was a significant decrease in sternum wound infections after
implementing the MRSA screenings.
The literature collectively supports surgical patients receiving implant devices,
cardiac procedures, and vascular surgeries are at risk for developing MRSA
infections.
Nursing Implications
While the data supports pre-operational MRSA screenings and proper PPE,
the literature also showed nursing noncompliance with contact precautions
to be a result of hospital acquired MRSA.'
It is recommended to place personal protection equipment close to contact
rooms in order to increase nursing compliance with contact precautions.
Increasing the number of patients screened for MRSA may lead to more
patients that require nurses to abide by contact precautions.
The data collected suggests prophylactic antibiotics for nasal carrier MRSA
patients. These antibiotics will need to be administered by nurses in a
timely manner in order to prevent surgical site infections.
Pictured below is the correct personal protective equipment (PPE) necessary for contact with a MRSA patient. A health care professional should don an isolation gown and gloves before entering the room.
Recommendations
for Further Research
Further research on this topic may include studies with other surgical patient groups such as respiratory or gastrointestinal patients. Also, more research on the effects of MRSA screenings throughout a surgical stay as opposed to only on admission or before a surgical procedure.
The graph above is from a hospital in Virginia after implementing MRSA screenings on admission in The number of CA-MRSA is high, but the number of HA-MRSA infections were relatively low.
Save a Patient's Life.
MRSA Screen Before the Knife.
Lauren Martin, RN
University of North Georgia