***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism . Decolonization of nasal and extranasal sites on hospital admission may reduce this risk . METHODS In a r and omized , double-blind , placebo-controlled , multicenter trial , we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction ( PCR ) assay , followed by treatment with mupirocin nasal ointment and chlorhexidine soap , reduces the risk of hospital-associated S. aureus infection . RESULTS From October 2005 through June 2007 , a total of 6771 patients were screened on admission . A total of 1270 nasal swabs from 1251 patients were positive for S. aureus . We enrolled 917 of these patients in the intention-to-treat analysis , of whom 808 ( 88.1 % ) underwent a surgical procedure . All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin . The rate of S. aureus infection was 3.4 % ( 17 of 504 patients ) in the mupirocin-chlorhexidine group , as compared with 7.7 % ( 32 of 413 patients ) in the placebo group ( relative risk of infection , 0.42 ; 95 % confidence interval [ CI ] , 0.23 to 0.75 ) . The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections ( relative risk , 0.21 ; 95 % CI , 0.07 to 0.62 ) . There was no significant difference in all-cause in-hospital mortality between the two groups . The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group ( P=0.005 ) . CONCLUSIONS The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission . ( Current Controlled Trials number , IS RCT N56186788 . Background Preoperative screening for nasal S. aureus carriage , followed by eradication treatment of identified carriers with nasal mupirocine ointment and chlorhexidine soap was highly effective in preventing deep-seated S. aureus infections . It is unknown how cost-effectiveness of this intervention is affected by suboptimal S. aureus screening . We determined cost-effectiveness of different preoperative S. aureus screening regimes . Methods We compared different screening scenarios ( ranging from treating all patients without screening to treating only identified S. aureus carriers ) to the base case scenario without any screening and treatment .  Screening and treatment costs as well as costs and mortality due to deep-seated S. aureus infection were derived from hospital data bases and prospect ively collected data , respectively . Results As compared to the base case scenario , all scenarios are associated with improved health care outcomes at reduced costs . Treating all patients without screening is most cost-beneficial , saving € 7339 per life year gained , as compared to € 3330 when only identified carriers are treated . In sensitivity analysis , outcomes are susceptible to the sensitivity of the screening test and the efficacy of treatment . Reductions in these parameters would reduce the cost-effectiveness of scenarios in which treatment is based on screening . When only identified S. aureus carriers are treated costs of screening should be less than € 6.23 to become the dominant strategy . Conclusions Preoperative screening and eradication of S. aureus carriage to prevent deep-seated S. aureus infections saves both life years and medical costs at the same time , although treating all patients without screening is the dominant strategy , result ing in most health gains and largest savings We analyzed the effect of perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment on the reduction of the postoperative wound infection rate in orthopedics . In an unblinded intervention trial , we compared 1,044 patients treated with mupirocin ( intervention group ) with 1,260 historical controls ( control group ) . From each group a r and om sample of 50 patients was taken . Risk factors were analyzed in these r and om sample s and we found it unlikely that different distributions of risk factors might have influenced the results . The wound infection rates were 14/1,044 in the intervention group and 34/1,260 in the control group ( p = 0.02 ) . The rates of wound infections caused by S. aureus were subsequently 7/1,044 and 14/1,260 ( p = 0.3 ) . On checking the data we found that prophylaxis had unintentionally not been given to 172 patients in the intervention group . Correction of the data gave a comparable total infection rate , but a further reduced infection rate by S. aureus . Our findings suggest that prophylactic treatment with mupirocin in orthopedic surgery can reduce the infection rate BACKGROUND Previous studies have demonstrated higher infection rates following orthopaedic procedures on the foot and ankle as compared with procedures involving other areas of the body . Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery . The purpose of the present study was to evaluate the efficacy of three different surgical skin-preparation solutions in eliminating potential bacterial pathogens from the foot . METHODS A prospect i ve study was undertaken to evaluate 125 consecutive patients undergoing surgery of the foot and ankle . Each lower extremity was prepared with one of three r and omly selected solutions : DuraPrep ( 0.7 % iodine and 74 % isopropyl alcohol ) , Techni-Care ( 3.0 % chloroxylenol ) , or ChloraPrep ( 2 % chlorhexidine gluconate and 70 % isopropyl alcohol ) . After preparation , quantitative culture specimens were obtained from three locations : the hallux nailfold ( the hallux site ) , the web spaces between the second and third and between the fourth and fifth digits ( the toe site ) , and the anterior part of the tibia ( the control site ) . RESULTS In the Techni-Care group , bacteria grew on culture of specimens obtained from 95 % of the hallux sites , 98 % of the toe sites , and 35 % of the control sites . In the DuraPrep group , bacteria grew on culture of specimens obtained from 65 % of the hallux sites , 45 % of the toe sites , and 23 % of the control sites . In the ChloraPrep group , bacteria grew on culture of specimens from 30 % of the hallux sites , 23 % of the toe sites , and 10 % of the control sites . ChloraPrep was the most effective agent for eliminating bacteria from the halluces and the toes ( p < 0.0001 ) . CONCLUSIONS The use of effective preoperative preparation solution is an important step in limiting surgical wound contamination and preventing infection , particularly in foot and ankle surgery . Of the three solutions tested in the present study , the combination of chlorhexidine and alcohol ( ChloraPrep ) was most effective for eliminating bacteria from the forefoot prior to surgery The objective of this study was to determine whether use of mupirocin nasal ointment for perioperative eradication of Staphylococcus aureus nasal carriage is effective in preventing the development of surgical site infections ( SSIs ) . A r and omized , double-blind , placebo-controlled design was used . Either mupirocin or placebo nasal ointment was applied twice daily to 614 assessable patients from the day of admission to the hospital until the day of surgery . A total of 315 and 299 patients were r and omized to receive mupirocin and placebo , respectively . Eradication of nasal carriage was significantly more effective in the mupirocin group ( eradication rate , 83.5 % versus 27.8 % ) . In the mupirocin group , the rate of endogenous S. aureus infections was 5 times lower than in the placebo group ( 0.3 % and 1.7 % , respectively ; relative risk , 0.19 ; 95 % confidence interval , 0.02 - 1.62 ) . Mupirocin nasal ointment did not reduce the SSI rate ( by S. aureus ) or the duration of hospital stay BACKGROUND Surgical site infection has been identified as one of the most important preventable sources of morbidity and mortality associated with medical treatment . The purpose of the present study was to evaluate the feasibility and efficacy of an institutional prescreening program for the preoperative detection and eradication of both methicillin-resistant and methicillin-sensitive Staphylococcus aureus in patients undergoing elective orthopaedic surgery . METHODS Data were collected prospect ively during a single-center study . A universal prescreening program , employing rapid polymerase chain reaction analysis of nasal swabs followed by an eradication protocol of intranasal mupirocin and chlorhexidine showers for identified carriers , was implemented . Surgical site infection rates were calculated and compared with a historical control period immediately preceding the start of the screening program . RESULTS During the study period , 7019 of 7338 patients underwent preoperative screening before elective surgery , for a successful screening rate of 95.7 % . One thous and five hundred and eighty-eight ( 22.6 % ) of the patients were identified as Staphylococcus aureus carriers , and 309 ( 4.4 % ) were identified as methicillin-resistant Staphylococcus aureus carriers . A significantly higher rate of surgical site infection was observed among methicillin-resistant Staphylococcus aureus carriers ( 0.97 % ; three of 309 ) compared with noncarriers ( 0.14 % ; seven of 5122 ) ( p = 0.0162 ) . Although a higher rate of surgical site infection was also observed among methicillin-sensitive Staphylococcus aureus carriers ( 0.19 % ; three of 1588 ) compared with noncarriers , this difference did not achieve significance ( p = 0.709 ) . Overall , thirteen cases of surgical site infection were identified during the study period , for an institutional infection rate of 0.19 % . This rate was significantly lower than that observed during the control period ( 0.45 % ; twenty-four cases of surgical site infection among 5293 patients ) ( p = 0.0093 ) . CONCLUSIONS Implementation of an institution-wide prescreening program for the identification and eradication of methicillin-resistant and methicillin-sensitive Staphylococcus aureus carrier status among patients undergoing elective orthopaedic surgery is feasible and can lead to significant reductions in postoperative rates of surgical site infection . LEVEL OF EVIDENCE Therapeutic Level III . See Instructions to Authors for a complete description of levels of evidence The endogenous or exogenous origin of Staphylococcus aureus , responsible for orthopaedic surgical-site infections ( SSI ) , remains debated . We conducted a multicentre prospect i ve cohort study to analyse the respective part of exogenous contamination and endogenous self-inoculation by S. aureus during elective orthopaedic surgery .  The nose of each consecutive patient was sample d before surgery . Strains of S. aureus isolated from the nose and the wound , in the case of SSI , were compared by antibiotypes or pulsed-field gel electrophoresis ( PFGE ) . A total of 3,908 consecutive patients undergoing orthopaedic surgery were included . Seventy-seven patients developed an SSI  ( 2 % ) , including 22 related to S. aureus ( 0.6 % ) . S. aureus was isolated from the nose of 790 patients ( 20.2 % ) at the time of surgery . In the multivariate analysis , S. aureus nasal carriage was found to be a risk factor for S. aureus SSI in orthopaedic surgery . However , only nine subjects exhibiting S. aureus SSI had been found to be carriers before surgery : when compared , three pairs of strains were considered to be different and six similar . In most cases of S. aureus SSI , either an endogenous origin could not be demonstrated or pre-operative nasal colonisation retrieved a strain that was different from the one recovered from the surgical BACKGROUND MRSA is a major economic and health issue internationally and as such is of particular importance in the appropriate management of orthopaedic patients . Bone , joint and implant infection can lead to unfavourable outcomes with a long protracted in hospital stay inevitable . The cost for the patient , the hospital and society are substantial . MATERIAL S AND METHODS This study was a review of a prospect ively maintained data base from our unit over three time points from 2005 to 2007 . At each time point a new infection control measure was implemented in an effort to reduce MRSA infections . Total rates of MRSA infection and colonisation in all orthopaedic patients were recorded , before and after separation of trauma and elective services , and after the introduction of a screening pre assessment clinic . RESULTS 12259 orthopaedic patients were review ed over the three years . The mean age of MRSA infected patients was 71 . A higher proportion of female patients were infected than male patients . The mean length of stay for infected patients was 23.4 days . The rate of infection dropped from 0 
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The S. aureus screening and decolonization protocol also saved costs in orthopaedic patients when comparing the costs of screening and decolonization with the reduction of SSIs .
Conclusions Preoperative screening and decolonization of S. aureus in orthopaedic patients is a cost-effective means to reduce SSIs .