opportunistic MRSA (testing pre-op)

There is a thread on another board about this and I found a site that says like 1/5 of the population are carriers of MRSA and that number is even higher among those associated with health care / health care workers. The article went on to say that these MRSA colonies are impotent until certain conditions arise (like surgery or illness). One surgeon advocated pre-op nasal swabs to test for MRSA as part of the pre-op screening. Has anyone heard of this practice? Do you think such a test would be warranted or a useless test? I hope Dr. L chimes in here.

Come on Dr. L chime in. I would love to here what you think. Will it help to swab the nose pre op?

Screening the general population would not really be indicated as the yield would be low, and the presence of MRSA in the environment is ubiqutous. If someone has a history of unexplained boils or unusual infections their nose gets swabbed as a source, but it's real rare. Some high risk patients undergoing open heart surgery are screened preop as a sternal wound infection can be lethal, but it's not something done otherwise.

A MRSA test was ordered and done before each of my procedures. I went to the lab to have the blood work done and my nose was swabbed. I think it's a great precautionary measure.

I was required to take the nasal swab MRSA carrier test before my first plastic surgery last November.  I had surgery at a brand new facility and they requested the test, not my surgeon.  The test cost $140 and I haven't had to repeat it with subsequent surgeries there. 

Well I do know the MRSA well... I am a medical social worker and yes....most of us if we were tested would be positive and possibly active..but when you are healthy it will not really affect you...the other way I know alot about this is my daughter, who is now 6 has cystic fibrosis and she tested + as a carrier in the NAIRS when she was just 6 months old.  Her CF doctor told me that I most likely passed it to her, or she could have been ner someone at the simple grocery store ans that since we both work in the medical field, we are most likely carriers...he said chances are if they tested everybody..we would all be carriers or even  postitive, but the difference is that we are not ill...if it is in an open wound..you just ahve to keep it covered...adn we do not even have to isolate a positive MRSA patient in nursing homes any longer in massachusetts..as long as they are 3 feet away from someone.....but when my daughter went into the hospital for some day surgery...she did ahve to be in a private area, which actually to me was better because there was no one in there and there was less of a chance of her catching something.  I do wear a mask when I must ahve contact with someone with MRSA in the NAIRS or sputum just because of abby, but as long as they don't cough on you or spit on you..you are safe.  It is a crappy "superbug" but I think personally as the medical feild is learning that we likely all carry it, it is getting less attention....

sigh.. now I'm more confused that before. Some people do.. some people don't... some docs say yes.. some docs say no... I guess it's time to call my PCP and wait for his nurse to call me back. (sighs again). I bet he is just going to tell me that he will do the test if I feel I need to but he wont tell me if I should. How frustrating. I need more feedback from my OH friends.

My surgeons required it as part of my pre-op testing.

Personally I always feel it's better to be safe than sorry.  I like the fact that they test because it makes me feel safer about the place I'm having my surgery done....I certainly do not want to catch anything while there.    It doesn't hurt, doesn't take more than a minute to do it so I have no problem with it.

Are you worried about doing it because you think it hurts?? If so, don't worry about it...no pain at all.

I think the answers vary depending on how much of an issue the individual surgeon and facility have had with MRSA.

My practice is to treat anybody at high risk for MRSA (health care workers, prior known MRSA infections, and household contacts of the above) who is undergoing surgery with chlorhexidine gluconate nail scrubs and body wash, mupirocin nasal swabs, and potentially an anti-MRSA drug prior to surgery.

I don't generally do the cultures.

Also, I insist on working only at facilties with an infection control nurse/process. (standard here for any accredited center.)  That way, I can know if infections are arising from the facility and if so, find out about isolating the source.

Also, any infections I may have must be reported. The facility then goes back and analyzes that patients records and all contacts,  to see if there were any common-source  exposures that other patients may have had and of course to trace the source if possible.

Having worked at M.D. Anderson and on a busy burn unit with highly susceptible patients, I am all about infection control.  It's as much about using a safe system of tracking and prevention as it is individually treating patients.

I don't know of any surgicenters that routinely screen for MRSA, personally.

The only reason I could see that it would be helpful is if you later had MRSA positive cultures at a surgical site, they would then know if you were already colonized before surgery, but the treatment would be the same anyway.

I have worked in 3 adult ICU units, and all patients at all 3 hospitals were nasally swabbed for MRSA on admission to ICU.  No matter what kind of patient (chronically ill, healthy but fell off a bicycle, took a Tylenol overdose, etc.).  Also, all ICU patients were bathed with chlorhexidine daily while in the hospital as a routine.

I disagree with treating for potential MRSA without positive cultures.  That's how the whole thing started to begin with.

Mupirocin has conflicting studies showing effectiveness against nasal colonization with MRSA and it is not routinely used  in the ICU even on MRSA positive patients.