Deby Evans

Deb Evans is the MVC Site Engagement Manager

An article published in The Journal of Arthroplasty in March 2017 discussed a study that compared universal treatment versus screening and treatment for Staphylococcus Aureus (S. aureus). The authors reviewed whether a universal screening and treatment decolonization protocol would result in a reduction for both surgical site infections and hospital costs, compared to only treating patients that screened positive for S. aureus.

Infections following joint replacement are costly to hospitals both in terms of patient outcomes and finances, especially if the infection is caused by methicillin resistant S. aureus which is more complex to treat. Treatment with intranasal mupirocin eliminates up to 85% of S. aureus colonization and the treatment protocol of mupirocin along with the use of chlorhexidine gluconate (CHG) as a topical antiseptic scrub, has been shown to reduce the incidence of postoperative joint infections from staphylococcus aureus.

The most common process for hospitals performing joint replacement is to screen all operative candidates for S. aureus and then treat those that test positive for colonization with the aforementioned products. However, this universal testing can raise preoperative costs due to increased supply usage, laboratory work and staffing for tracking results and contacting patients. In addition, a significant number (up to 15%) of S. aureus positive patients may be missed. An alternative solution is to waive testing and treat all surgical joint candidates with mupirocin and CHG cleansing.

Within the study, for a first cohort screening took place, and only surgical candidates that tested positive for S. aureus were treated. After a brief hiatus to allow for treatment transition, a second cohort was treated universally with mupirocin and CHG. Results, monitored through the infection prevention department of the facility, indicated a decreased number of surgical site infections as well as less infections caused by methicillin-susceptible and methicillin-resistant S. Aureus in the cohort treated universally with mupirocin and CHG.  The study also determined that with a universal treatment protocol, where all surgical candidates were treated hospital costs were decreased not only from reduced laboratory testing but also from reduced readmissions for treatment of surgical site infections.

One healthcare concern noted in the study is the risk of mupirocin resistance. However, the authors felt that the benefits in terms of reduced surgical site infections and cost savings outweighed this risk. MVC hospitals may wish to consider reviewing their treatment protocols and evaluate if using a universal treatment plan is worth implementing in their facility. For more information on the study click here

If you have any questions, please do not hesitate to contact the MVC Coordinating Center, Deb Evans (debevans@med.umich.edu) or Abeer Yassine (abeery@med.umich.edu)  or directly comment on this article. We welcome your comments and feedback.