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- Wheeless' Textbook of Orthopaedics
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Duke Orthopaedics
Wheeless' Textbook of Orthopaedics

- How We are Committed to Protecting Your Safety:

What is MRSA?
       MRSA is a type of staphylococcus that is resistant to the commonly used antibiotics, extremely contagious, and that can cause aggressive
       infections to patients.  The saving grace with this type of infection, is that it can be readily cultured so that its presence can be
       identified before, during, and after surgery.  Early diagnosis and treatment is critical for successful treatment.
       - references:
MRSA infection from the Mayo Clinic 
Healthcare-associated MRSA
              - Methicillin-resistant Staphylococcus aureus from Wikipedia
              - Understanding MRSA (Methicillin resistant Staphylococcus aureus) from Web MD
              - MRSA Resources
              - MRSA infection from Medline Plus
              - MRSA Watch 


Here are Specific Precautions that We take Before Surgery to Prevent Infection:

     - Nasal Screening for Bacteria:
    Recent evidence has shown that MRSA is often carried in the nasal passages which
          serves as a source for postoperative infections. At OSNC all of our surgeons, physician
          assistants, and operative nurses have been screened and have been found negative for MRSA.
          We screen all of our surgical patients for MRSA, and will insist on proper cleansing methods for
          any MRSA positive patients prior to surgery.

          - references:
                  - Use of Intranasal Mupirocin and Chlorhexidine Bathing and Incidence of MRSA Colonization and Infection Among ICU Patients.
                  - The role of MRSA screening in joint-replacement surgery.
                  - Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control.
                  - Preop use of mupirocin for the prevention of healthcare-associated Staphylococcus aureus infections: a cost-effectiveness analysis.
                  - Controlling the usage of intranasal mupirocin does impact the rate of S aureus deep sternal wound infections in cardiac surgery patients


Here are Specific Precautions that We take in the OR to Prevent Infection:

       - antibiotics:
              - prophylactic antibiotics (ancef vs vancomycin - depending on your nasal screening)
addition of antibiotics to cement (Cobalt™ G-HV Bone Cement from Biomet)
       - skin preparation:
              - skin prep agents (ChloraPrep)
              - 3M™ Ioban™ 2 Antimicrobial Incise Drape   
       - perioperative oxygen 
       - suture choice:
              - PDS plus suture:
       - normothermia
              - Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten Hospitalization 
       - operating room hygiene:
                    - sterile tourniquet                                                                                      
                             - Microbial colonization of tourniquets used in orthopedic surgery. 
                    - OR lights - hands off
                             - The hygienic significance of operating lights 
                    - surveillance cultures:
                             - Intraop Contamination Influences Wound Discharge and Periprosthetic Infection. 
Transfer of bacteria between biomaterials surfaces in the operating room. 
Perioperative contamination in primary total hip arthroplasty.
                    - body exhaust suits
                              - Body-exhaust suit versus occlusive clothing 
                    - double gloving: 
                              - Glove perforation in pediatric orthopedic practice. 
Glove perforation in ortho and trauma surgery. 
Glove perforation and contamination in primary total hip arthroplasty

Wound Closure Techniques:



    After Your Surgery - How to Prevent Infection:
            - wound management
closed suction dressing
topical antimicrobials: bacitracin  and silvadene






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Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Saturday, June 26, 2010 9:11 pm