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Orthopedic Surgical Site Infections and Screening Intervention Essay

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Methicillin-resistant Staphylococcus aureus (MRSA) can cause a wide range of infections. Such infections can result in mortality and morbidity. Staphylococcus aureus is “a common pathogen widely common in prosthetic joint infections” (Ng & Awad, 2015, p. 2). The purpose of this study is to understand how an effective preoperative MRSA screening protocol can be used as a powerful strategy to minimize orthopedic surgical site infections (Alexander & Wang, 2015).

Search Method

A rigorous strategy was used to select the most desirable peer-reviewed journal articles for this study. The major databases used to collect the required information included Science-Direct, the British Medical Journal (BMJ), and Evidence-Based Nursing (EBN). Several keywords were also used to select quality articles for the study. The keywords used are presented below.

  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • MRSA screening
  • Orthopedic site infection
  • Quality improvement
  • Quality healthcare delivery

On top of that, a powerful criterion for exclusion and inclusion was used. For instance, articles published within the last five years were considered for inclusion. The other consideration was to ensure the articles addressed the issue of MRSA infection. The selected articles presented evidence-based ideas and arguments. A total of 10 peer-reviewed journal articles were selected for the study.

Summary of Research Studies

Akhtar, A., Kadir, H., & Chandran, P. (2014). Surgical site infection risk following pre-operative MRSA detection in elective orthopedic surgery. Journal of Orthopaedics, 1(1), 11117-11120.

This article indicates that patients undergoing orthopedic surgery have higher chances of MRSA infection. Over 80 percent of the targeted patients had been colonized with MRSA. The study shows clearly that a preventative or screening strategy can minimize the risk of MRSA infection. Patients should therefore “be sensitized about the increased surgical site infection if colonized with MRSA pre-operatively” (Akhtar, Kadir, & Chandran, 2014, p. 11117). However, the article fails to propose adequate solutions to deal with this problem.

Alexander, C., & Wang, L. (2015). Infection control: methicillin-resistant Staphylococcus aureus. American Journal of Infectious Diseases, 11(3), 74-82.

The scholars conducted an extensive literature review to understand the problem of MRSA infection. After conducting the study, the authors indicated that early isolation and identification for the pathogen could deal with the health problem (Alexander & Wang, 2015). This should also be done at the point of entry. The main strength is that the study offers new approaches towards dealing with various healthcare-associated infections (HAIs).

Charles, K., Nathan, L., Blake, B., Maureen, S., Gary, S., & David, L. (2016). Is staphylococcal screening and suppression an effective interventional strategy for the reduction of surgical site infection? Surgical Infections, 17(2), 158-166.

The study analyzed the current use of topical mupirocin in many hospitals as the best procedure for nasal decolonization. According to the authors, the screening methods were selective and controversial. However, studies have indicated that suppression and screening reduce SSI infections. The scholars proposed that the best surveillance strategy should be based on the risk-levels of patients undergoing surgical procedures (Charles et al., 2016). The study, however, fails to offer the best alternative for dealing with MRSA infections.

Duerden, B., Fry, C., Johnson, A., & Wilcox, M. (2015). The control of methicillin-resistant Staphylococcus aureus bloodstream infections in England. Open Forum Infectious Diseases, 2(2), 1-12.

A powerful research approach was used by the scholars. This was done by analyzing the major campaigns that managed to reduce MRSA infections. That being the case, the study also explains how the implementation of national infection prevention directions and expert improvement teams can deliver positive results. However, the authors fail to outline new screening strategies for MRSA (Duerden, Fry, Johnson, & Wilcox, 2015).

Jokinen, E., Laine, J., Huttunen, R., Arvola, P., Vuopio, J., Lindholm, L.,…Syrjanen, J. (2015). Combined interventions are effective in MRSA control. Infectious Diseases, 47(11), 801-807.

This study entailed the use of various infection prevention measures and screening protocols. The scholars wanted to understand how the MRSA pandemic could be minimized. They concluded that the use of universal screening methods was effective in containing the epidemic (Jokinen et al., 2015). As well, they indicated that the Pirkanmaa epidemic (PE-MRSA) was becoming a major challenge.

MacFadden, D., Elligsen, M., Robicsek, A., Ricciuto, D., & Daneman, N. (2013). Utility for prior screening for methicillin-resistant Staphylococcus aureus in predicting resistance of S. aureus infections. CMAJ, 185(15), 725-730.

The purpose of the study was “to evaluate the effectiveness of MRSA screening in predicting the resistance of clinical isolates of S. aureus” (MacFadden, Elligsen, Robicsek, Ricciuto, & Daneman, 2013, p. 726). The method can be used to minimize MRSA infection in every healthcare setting. The main weakness of the study is that it fails to describe how medical professionals can improve the nature of screening for MRSA to minimize nosocomial spread (MacFadden et al., 2013).

Mehta, S., Hadley, S., Hutzler, L., Slover, J., Phillips, M., & Bosco, J. (2013). Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden. Clinical Orthopaedics and Related Research, 471(7), 2367-2371.

The authors used a power study design to come up with their findings. They wanted to understand the best ways to decolonize the MRSA burden. The study showed conclusively that “the implementation of a staphylococcal decolonization protocol at a single specialty orthopaedic hospital decreased the prevalence density of MRSA” (Mehta et al., 2013, p. 2367). The ideas can be replicated elsewhere to address this health concern.

Ng, W., & Awad, N. (2015). Performance improvement initiative: prevention of surgical site infection (SSI). BMJ Quality Improvement Programme, 4(1), 1-3.

Hospitals performing numerous surgical procedures should have safety measures to prevent SSIs (Ng & Awad, 2015). Mafraq Hospital, therefore, developed a multidisciplinary team to implement the best measures to eliminate surgical site infections (SSIs). The authors, therefore, show that the continued use of proper medical practices can help prevent the major causes of SSIs. These evidence-based ideas are applicable in many hospitals.

Thompson, P., & Houston, S. (2013). Decreasing methicillin-resistant Staphylococcus aureus surgical site infections with chlorhexidine and mupirocin. American Journal of Infectious Diseases, 41(7), 629-633.

The authors outlined the best ways that can be used to eliminate MRSA SSIs. The authors used past studies to examine how various hospitals used different strategies to deal with the MRSA epidemic. The analysis showed that “intranasal mupirocin and non-rinse 2% chlorhexidine gluconate cloths were beneficial in preventing MRSA infections in the non-general surgery population” (Thompson & Houston, 2013, p. 630).

Al-Mulhim, F., Baragbah, M., Sadat-Ali, M., Alomran, A., & Azam, M. (2014). Prevalence of surgical site infection in orthopedic surgery: a 5-year analysis. International Surgery, 99(3), 264-268.

This outstanding article explains why emergency surgical operations carry the greatest share of MRSA risk. Many patients record new health problems and death due to such infections. The scholars, therefore, propose the use of proper measures to control MRSA infection (Al-Mulhim, Baragbah, Sadat-Ali, Alomran, & Azam, 2014). The article also shows clearly that the use of antibiotics may not be sufficient for dealing with the problem.

List of References

Akhtar, A., Kadir, H., & Chandran, P. (2014). Surgical site infection risk following pre-operative MRSA detection in elective orthopaedic surgery. Journal of Orthopaedics, 1(1), 11117-11120.

Alexander, C., & Wang, L. (2015). Infection control: methicillin-resistant Staphylococcus aureus. American Journal of Infectious Diseases, 11(3), 74-82.

Al-Mulhim, F., Baragbah, M., Sadat-Ali, M., Alomran, A., & Azam, M. (2014). Prevalence of surgical site infection in orthopedic surgery: a 5-year analysis. International Surgery, 99(3), 264-268.

Charles, K., Nathan, L., Blake, B., Maureen, S., Gary, S., & David, L. (2016). Is staphylococcal screening and suppression an effective interventional strategy for reduction of surgical site infection. Surgical Infections, 17(2), 158-166.

Duerden, B., Fry, C., Johnson, A., & Wilcox, M. (2015). The control of methicillin-resistant Staphylococcus aureus bloodstream infections in England. Open Forum Infectious Diseases, 2(2), 1-12.

Jokinen, E., Laine, J., Huttunen, R., Arvola, P., Vuopio, J., Lindholm, L.,…Syrjanen, J. (2015). Combined interventions are effective in MRSA control. Infectious Diseases, 47(11), 801-807.

MacFadden, D., Elligsen, M., Robicsek, A., Ricciuto, D., & Daneman, N. (2013). Utility for prior screening for methicillin-resistant Staphylococcus aureus in predicting resistance of S. aureus infections. CMAJ, 185(15), 725-730.

Mehta, S., Hadley, S., Hutzler, L., Slover, J., Phillips, M., & Bosco, J. (2013). Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden. Clinical Orthopaedics and Related Research, 471(7), 2367-2371.

Ng, W., & Awad, N. (2015). Performance improvement initiative: prevention of surgical site infection (SSI). BMJ Quality Improvement Programme, 4(1), 1-3.

Thompson, P., & Houston, S. (2013). Decreasing methicillin-resistant Staphylococcus aureus surgical site infections with chlorhexidine and mupirocin. American Journal of Infectious Diseases, 41(7), 629-633.

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