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Methicillin-resistant Staphylococcus aureus screening is important for surgeons
Ann Hepatobiliary Pancreat Surg 2019 Aug;23(3):265-73
Published online August 31, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Il-Kwang Hyun1,*, Pyoung Jae Park1,2,*, Dawon Park1,3, Sae Byeol Choi1,2, Hyung Joon Han1,4, Tae-Jin Song1,4, Cheol-Woong Jung1,3, and Wan-Bae Kim1,2

1Department of Surgery, Korea University College of Medicine, 2Department of Surgery, Korea University Guro Hospital, 3Department of Surgery, Korea University Anam Hospital, Seoul, 4Division of Hepatobiliopancreas and Transplant Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
Received March 7, 2019; Revised April 22, 2019; Accepted April 30, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Perioperative surgical site infection (SSI) remains a morbid complication even in successful surgical procedures. We encountered an unusual experience of a methicillin-resistant Staphylococcus aureus (MRSA)-related SSI outbreak in our hospital; therefore, we conducted an epidemiologic analysis to determine the origin of SSIs due to MRSA.
Methods: Among 102 consecutive patients who underwent hepatobiliopancreatic operations, SSIs occurred in eight cases. Infection surveillance regarding the operative environment was carried out. We analyzed the possible risk factors for this infectious outbreak in our institution.
Results: Patients with SSI tended to be older (p=0.293), had variable operation fields (p=0.020), more cancer-related operation (p=0.003), less laparoscopic surgery (p=0.007), performed in operation room 1 (p=0.004), prolonged operation time (p<0.001) and had longer hospital stays (p=0.002). After propensity score (PS) matching, there was the only significant difference in the participation of surgeon D as a second assistant (p=0.001) between the SSI and non-SSI group. After PS matching, surgeon D as a second assistant was the only significant risk factor for MRSA SSI in the univariate (p=0.001) and multivariate analysis (p=0.004, hazard ratio=25.088, 95% confidence interval=2.759-228.149).
Conclusions: Outbreak of SSIs occurred due to transmission of MRSA from a surgeon to patients despite the standard regulation of infection control. These SSIs were associated with an excessive incidence of surgeon’s nasal and hand carriage of the MRSA strain identified in the surgeon via cultures. We recommend the preoperative regular nasal and hand screening for MRSA among surgeons.
Keywords : Surgical site infection; Methicillin-resistant Staphylococcus aureus; Screening


August 2019, 23 (3)