Surgical Site Infection Prevention Program
Get Excellent Orthopedic Care at PVHMC
What You Can Do To Prepare For Surgery
Staphylococcus aureus or “Staph” is a germ that lives on the
skin and in the nose of some healthy people. Your skin protects you from
those germs. When you have surgery, we will be cutting your skin. Sometimes
germs can get into those cuts and cause infection.
PVHMC will swab your nose at your Pre Op appointment, 14 days before surgery,
to see if you have Staph. The test will take 3-5 days to get the results.
The results will be communicated to your Surgeon. A positive test means
that Staph is present (this is referred to as being “colonized”)
but does not mean you have an infection or illness.
Showering before Surgery
To decrease the amount of germs on your skin, PVHMC is providing you with
a medicated soap called
Chlorhexidine Gluconate 4% and instructions to cleanse the skin for FIVE consecutive nights before
surgery. You will receive this packet when you complete your pre op admission
appointment at the hospital. Start the showering process 5 nights before
your surgery. (Example: If your surgery date is April 16th then start
the showering on April 11th.) The showering is done whether or not the
nasal screen is positive or negative for Staph.
CHG 4% Showering
PVHMC Pre Op Skin Preparation Packet contains 2 bottles of the medicated
Chlorhexidine Gluconate (CHG) 4%, a measuring cup, 5 cloth mittens and showering instructions. The instructions
will provide you with specific information about
showering for FIVE nights in a row before your surgery. Read the showering instructions completely before showering. Follow the
instructions for all 5 showers.
Positive Test for Staph
If your test is positive, your surgeon’s office will call you and
ask you for the information to your preferred pharmacy. They will call
in a prescription for
Mupirocin ointment which you will need to pick up from your pharmacy. The medicine will come
in one large tube or many small packets. You can call your Clinical Coordinator
for any questions concerning the showering and ointment application.
Mupirocin Ointment Application (only if positive for Staph)
Apply a pea size amount of the ointment to a cotton swab. Place the cotton
swab inside your nose, applying the ointment to the inside of the nose.
Remove cotton swab and discard. Apply a pea size amount of the ointment
to another cotton swab. Place the cotton swab inside the other side of
your nose, applying the ointment to the inside of the nose. Remove cotton
swab and discard. Gently press your nose together and release, together
and release for about one minute to get the medicine all over the inside
of your nose.
Do this once in the morning and once at night for FIVE days before surgery
(the same FIVE days you are showering with CHG soap.) Complete the checklist on the showering instruction sheet for the Mupirocin
Day of Surgery
Bring with you the completed checklist (on the showering instruction sheet)
and give to the holding room RN (this is the nurse getting you ready for
surgery). When you arrive to the holding room you will be given CHG cloths
to wipe with from “the neck down except the genitals” before
you get dressed in your hospital gown. Before surgery you will receive
antibiotics that are appropriate for you according to the nasal swab results.
MRSA (Methicillin-Resistant Staphylococcus Aureus)
If you have a type of Staph called MRSA you will be placed on “Contact
Isolation”. This means your doctors and nurses will wear gloves
and gowns when taking care of you. We do this to make sure we do not spread
MRSA to another patient we are caring for. Your family and visitors will
also need to wear gowns and gloves when they visit you in the hospital.
When leaving your room, they will need to remove the gowns and gloves
and clean their hands with alcohol rub found in the room or the isolation
cart outside the room.
For any questions, call your Clinical Coordinator at PVHMC or call Pre
Admission Testing at PVHMC at (909) 865-9546.
References: vll 2/2016; EBBP: AAOS, Orthopaedic Infection Prevention and
Control: An Emerging New Paradigm. 2010. EBBP: IHI. How-to Guide: Prevent
Surgical Site Infection for Hip and Knee Arthroplasty. 2012. EBBP: AORN,
Evidence for Using Chlorhexidine Gluconate Preoperative Cleansing to Reduce
the Risk of Surgical Site Infection. Nov 2010.