Date of Paper/Work

12-2013

Type of Paper/Work

Systems Change Project

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Roberta J. Hunt

Abstract

Staphylococcal carriage, particularly Methicillin-resistant Staphylococcus aureus (MRSA), is a risk factor for surgical site infection (SSI). The purpose of this project was to determine whether adult patients undergoing total hip and total knee arthroplasty could be successfully decolonized of MRSA beginning on the day of surgery, and if decolonization would reduce surgical site infection (SSI) rates.

The study employed two theoretical frameworks: Nola Pender’s Health Promotion Model and Kurt Lewin’s Change Theory. The sample consisted of 50 patients, 10 cases and 40 controls, selected from a convenience sample of 299 patients who underwent total hip or total knee arthroplasty from May 1, 2012 to May 1, 2013 at a large Midwestern teaching hospital. A case-control study design was utilized. Data was collected using retrospective chart review.

Characteristics of cases and controls were compared on categorical variables using Chi-square statistics. Fisher Exact tests were used when expected cell frequencies were less than 5. For continuous variables, independent group t-tests were used for comparisons. Evaluation of change in infection rates pre to post surgery was done using the Wilcoxon test. The small sample size precluded meaningful inferential statistical tests related to these variables.

MRSA colonization in the cases was reduced from 100% to 30% (7/10) pre to post surgery in the case patients. No prediction can be made about reducing SSI related to the limited sample size. A multisite study is recommended to address this limitation.

This pilot project suggests that screening for existing nasal MRSA and beginning decolonization on the day of surgery for patients undergoing THA or TKA surgery may effectively result in temporary decolonization during the perioperative period and may potentially prevent a MRSA SSI.

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