Why Is a Nasal Swab Necessary?

Why Is a Nasal Swab Necessary?

Many bacteria that colonize our bodies actually live in our airways and especially in our nose. One method of detecting this type of bacterial colonization is to do nasal screening. Studies have shown that patients who undergo nasal screening and decolonization can have a significantly lower risk of infection. By treating just the patients that are colonized, we can decrease the likelihood of creating resistant organisms and needlessly going through the effort and expense of decolonizing patients that are not colonized.

The most common organism that leads to infection following joint replacement is Staph Aureus, and the nasal swab-screening test looks for this bacteria. We currently screen all patients for Staph Aureus prior to joint surgery in an effort to reduce the possibility of infection.

What Are Staph Aureus & MRSA?

Staph Aureus is a common type of bacteria that lives on the skin or in the nasal passages of about one in four healthy people. The apparent bacteria do not always cause problems or infections, but those affected are said to be colonized with staph. If the staph bacteria enters a person’s body through a cut, sore, catheter, or breathing tube, it may cause an infection.

MRSA (Methicillin Resistant Staphylococcus Aureus) is a bacterium from the staph family and is resistant to commonly used antibiotics. It is typically harmless to healthy people; however, carriers of MRSA are at an increased risk of the bacteria getting into their wound during surgery and possibly causing an infection. Up to one in 20 persons can carry MRSA on their skin or in their nose. MSSA (Methicillin Susceptible Staphylococcus Aureus) is readily treated by common antibiotic but also has the potential to cause infections.

What Does the Screening Entail?

When you schedule your surgery, you will have a nasal swab done in clinic. A cotton swab will be placed in your nose to get a sample. The process is painless and only takes a few seconds. The sample will then be sent to the lab to have cultures done, with results returning to your provider in five to seven days.

What If I Test Positive?

Many people are carriers of MRSA/MSSA. This does not mean you are ill or a risk to other healthy people. If your culture results come back positive, we contact our patients and send additional instructions, including a decolonization process.

This process will involve the use of a special body wash (chlorhexidine or Hibalcens®) and ointment prior to surgery. You can also minimize your risk of becoming recolonized by using clean linens and clothing, and taking other hygiene precautions. 

What If I Test Negative?

We will only contact patients with a positive result prior to surgery. If we do not contact you, continue the following hygiene routines:

  • Bathe regularly.
  • Clean your hands with soap and water or an alcohol-based hand sanitizer.
  • Avoid reusing or sharing personal items.
  • Examples: disposable razors, linens, towels, and the like.
  • Maintain clean sheets, clothing, and home.
  • Wear clean, washed clothing for the five days leading up to surgery.
  • Wash all eating utensils after each use. 

In addition, you will be given an anti-bacterial (chlorhexidine or Hibalcens®) wash to use prior to surgery.

Chlorhexidine Shower Instructions:

  • Use the chlorhexidine soap for your shower the night before and the day of the surgery.
  • Use your normal shampoo on your hair.
  • Apply the chlorhexidine soap from the neck down.
  • While standing out of the stream of the shower, apply to the skin, and rub in gently.
  • Soak for five minutes, and then rinse the chlorhexidine soap off.
  • Do not use regular soap after the chlorhexidine soap, as the chlorhexidine soap bonds to the skin and with repeated use has a cumulative effect. It continues to work with anti-microbial activity after it is rinsed off.
  • Do not use the chlorhexidine soap if you have an allergy. There is a low risk for skin irritation with the use of this soap.