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Dr. Ebraheim’s educational animated video describes tests that orthopaedic surgeons should think about - Screening for MRSA. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Strategy for Prevention of Surgical Site Infection • Optimization of the patient before surgery o Make sure the patient is nutritionally fit o Need to deal with patients who smoke o Diabetic patients o Overweight patients o Need to improve the skin and soft tissue condition (area where the incision will be) • Try to reduce the bacterial burden that the patient is carrying o Immediately before the surgery, you will give the patient prophylactic preoperative antibiotics and try to decrease the contamination in the operating room o The patient may bring the organisms on themselves to the operating room (about 80% of these organisms are brought by the patient) o Do screening for Methicillin-Sensitive Staphylococcus Aureus (MSSA) or Methicillin-Resistant Staphylococcus Aureus (MRSA) and decolonization. o If you identify these patients that are carriers and treat them before they go to the hospital, that will reduce the infection rate for these patients. Once these patients (carriers) are in the hospital, it may be possible to then spread the bacteria they are carrying to other patients. Proper hand washing practices is very important to prevent the spread of bacteria. How can we decrease the bacterial burden of the patient bringing these organisms to the operating room? What are the tests that we should do? How can we help the situation when the patient is in the clinic or in the office? • Do screening for MSSA or MRSA and then do decolonization • Some patients have large reservoirs of bacteria (carriers) and these are the patients who will have an increased risk of surgical site infection o These reservoirs of bacteria are located in the nose, the axilla, the groin, and the perianal area o You want to identify these patients and eradicate the bacteria so that you can decrease the risk of surgical site infection Being a MRSA carrier will increase the chances of infection (about 10x more risk for surgical site infection). You wouldn’t know that a patient is a MRSA carrier unless you test them. It is important to identify these MRSA carriers so that we can give them the proper antibiotics, such as Vancomycin. A MRSA “carrier” is a person who can carry the bacteria without necessarily becoming ill. About 2% of the population are MRSA carriers. MRSA is a contagious bacteria that is difficult to treat because it is resistant to most commonly used antibiotics. What makes MRSA contagious? In the bacteria cell wall, there is a penicillin binding protein. When penicillin is able to bind to the binding protein of the cell wall, disruption of the cell wall and destruction of the bacteria is possible.