Pre-surgery screening reduces staph infections

Erickson 46Before a patient undergoes surgery to replace a hip or a knee, it helps to know the condition of the nose.

Approximately one in three people have Staphylococcus aureus (staph) bacteria inside their noses. This colonization is generally harmless, but if these bacteria get into a surgical incision they can cause a severe infection.

A multicenter study led by infection control experts with University of Iowa Health Care found that the rate of surgical-site infections (SSIs) dropped in patients undergoing hip or knee replacement procedures or heart surgery when they were screened for the presence of staph bacteria in their noses, followed by a series of simple interventions. Those who tested positive applied an antibiotic ointment in their noses and bathed with an antimicrobial wash for up to five days before surgery. All patients were given antibiotics just before surgery.

Herwaldt-Loreen 3
Loreen Herwaldt

“If they do carry the staph bacteria, the protocol we describe in the paper can lower their risk of a serious staph infection by about 40 percent,” says Loreen Herwaldt, MD, UI professor of internal medicine, director of hospital epidemiology at UI Hospitals and Clinics, and senior author on the study, which was published in the June 2 issue of the Journal of the American Medical Association.

Twenty hospitals in nine states participated in the study. Overall, 101 complex staph SSIs occurred after 28,218 operations during the pre-intervention period and 29 occurred after 14,316 operations during the intervention period. The rates of complex staph SSIs decreased for hip or knee replacement by 17 for every 10,000 operations, and by six for every 10,000 heart operations.