Problem: Development of a surgical site infection (SSI) is a risk after pediatric scoliosis surgery, with rates ranging from 1-24% and may be higher for children with neuromuscular or syndromic disorders. Intranasal colonization of Methicillin Resistant Staphylococcus Aureus (MRSA) can be a cause of SSIs in pediatric spine patients as it is transferred from the nares to the surgical incision. Purpose: The purpose of this quality improvement project is to streamline the intranasal MRSA screening process in at-risk pediatric patients < 26 years of age who were scheduled for scoliosis spine surgery. Methods: A defined process was developed beginning in the pediatric orthopedic clinic where neuromuscular, at-risk scoliosis patients were identified and screened for intranasal MRSA by performing a nasal swab at their pre-operative visit and then treated with an intranasal antibiotic for 7 days prior to day of surgery. The swabbing result is tracked by the care team, and if positive for MRSA colonization, targeted intravenous antibiotics were administered within 60 minutes of surgical incision. The patient was then followed for any signs or symptoms of an SSI during the hospital stay and at discharge. Results: Implementation of this MRSA surveillance program identified at-risk preoperative pediatric spine patients who were potential nasal carriers of MRSA, nasal swabbed at the pre-op visit, and monitored for a positive colonization result. Treating with intranasal antibiotic ointment before surgery has been the standard process and adding MRSA surveillance offered an additional opportunity to identify MRSA colonization and prevent SSIs. Results demonstrated negative results for pre-op MRSA colonization on eligible patients and one SSI on a patient who was not swabbed pre-operatively. Conclusions: Adding an extra layer of MRSA surveillance to the at-risk pediatric scoliosis surgical patient can diagnose a life-threatening infection and prevent development of SSIs.