At the NYU Langone Medical Center, if you're scheduled for total joint or spine surgery, you're scheduled to have your nose swabbed for a culture test for MRSA and then given a prescription of mupirocin to take in the weeks before surgery. Any patient who is positive for MRSA also gets a treatment of vancomycin.

The cost per patient is about $115 ($20 for the culture test; $90 for the mupirocin; and $4 for the vancymycin, when needed.) The program easily pays for itself, since an infection can cost $60,000 or more. "You don't have to reduce infections by very much to make it cost effective," James Slover, MD, MS, an orthopedic surgeon at the New York medical center, told Outpatient Surgery Magazine.

Dr. Slover and colleagues are now trying to find out exactly how effective universal screening and decolonization really is. But this may take some time since the hospital's infection rate for total joint and spine procedures is already just 1%. They will have to gather more data in order to know whether the program has resulted in a significant change in the infection rate, says Dr. Slover.

The program has been in place for about a year and half. As part of their pre-admission testing, every total joint and spine patient is tested for MRSA by nose culture. And every patient is decolonized with mupirocin. The culture results come back in a week. Any positive patients receive a treatment of vancomycin before surgery. When the patient arrives for surgery, staff asks whether the patient complied with the prescription for mupirocin. Any patient who is not compliant gets a prescription for muprirocin and receives vancomycin prior to surgery, says Dr. Slover.

The medical center is looking into purchasing a polymerase chain reaction system that would give same-day results and allow patients to receive vancomycin sooner, when needed, says Dr. Slover, who discussed the details of the screening program this month at the annual meeting of the American Academy of Orthopedic Surgeons in New Orleans.

Kent Steinriede