Elective Surgery and Active MRSA Screening

Select ONE case from below. Elective Surgery and Active MRSA Screening. Read the case and summarize the main points.  Answer the question s associated with the case and provide a rationale for your answers. State why the answer you chose is the correct one and why the other options are incorrect.  Support your answers with information from related literature. (Consult the NHSN link under Reading & Resources to help with answering the case study questions.)

Case #1:

Patient is admitted to the hospital on 04/12 for elective surgery and active MRSA screening test is positive. On the same day, patient undergoes small bowel resection (SB). Postoperative course is unremarkable; patient discharged on 4/16. On 4/29, patient is readmitted with a red, angry wound that is opened into the fascial level by the surgeon and is cultured. On 5/1, culture results are positive for MRSA.



– Is this an HAI?

A. Yes

B. No


– What infection should be reported?





E. Organ/Space


– If so, what is the date of onset?


Case # 2

Patient had an ORIF of the L. tibia (FX) on Nov 12. His course was uneventful and he was discharged on Nov 20. He was readmitted on Dec 3 with purulent drainage growing MRSA from the proximal pin site with a matching positive blood culture. Elective Surgery and Active MRSA Screening



– What should be reported?

A. SSI and secondary BSI


C. SSI only

D. None of the above


– What is the rationale for your choice of what should be reported?



Case #3

75-year-old patient admitted for bowel obstruction. 5/15 taken to OR and a COLO and SB procedures are performed through a single incision.

5/19: Patient spikes temp to 38 C, has abdominal pain and emesis. Ultrasound shows fluid collection in abdominal cavity. Fluid specimen for culture is obtained by needle aspiration.

5/20: Culture positive for E. faecium, many neutrophils seen.



– Is this a reportable HAI?


– If so, what is your rationale?


– What type of HAI is this?


Case #4

Patient underwent a coronary artery bypass graft with a left radial artery harvest site (CBGB) on January 6. On January 23, he experienced purulent drainage from the harvest site superficial incision. An aseptic specimen was obtained during a follow up visit with his surgeon, which grew MRSA. On February 18, patient reported pain and induration at the chest incision and the surgeon diagnosed “mediastinitis”.



– What should be reported? Choose the best answer.

A. Mediastinitis – SSI-MED at primary (chest) incision.

B. Superficial incisional SSI at the harvest (arm) site.

C. Both A and B.

D. Do not report either.


– What is the rationale for your answer?

Elective Surgery and Active MRSA Screening

provide rationale


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