Methicillin sensitive staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Health Economics

Background:

• Periprosthetic joint infection (PJI) is a severe complication of arthroplasty, leading to increased patient morbidity, mortality, and significant financial burden.
• Methicillin-sensitive Staphylococcus aureus (MSSA) is a common pathogen in PJI, with nasal and skin colonization identified as a major risk factor for developing infection.
• Current management strategies for PJI are complex and costly, highlighting the need for effective preventative measures.

Purpose of the Study:

• To evaluate the effectiveness of a pre-operative MSSA screening and decolonisation protocol in reducing PJI rates following primary joint replacement.
• To assess the cost-effectiveness of implementing such a screening program in a clinical setting.

Main Methods:

• A prospective study comparing PJI rates before and after the introduction of an MSSA screening and decolonisation protocol (Octenisan body wash and nasal Bactroban).
• Infection data was collected for 12,910 primary arthroplasties performed between 2007 and 2014.
• The protocol involved screening patients for MSSA and administering topical treatment to positive cases prior to and after surgery.

Main Results:

• The incidence of MSSA PJI decreased from 0.75% to 0.25% after the screening program's implementation (p < 0.0001).
• Overall PJI rates declined from 1.92% to 1.41% (p = 0.03), with a notable reduction in hip arthroplasties (3% to 1.5%, p = 0.002).
• The program successfully prevented 47 PJI cases, with an estimated cost saving of £1893 per infection prevented.

Conclusions:

• The pre-operative MSSA screening and eradication protocol is highly effective in reducing the incidence of MSSA PJI in primary joint replacements.
• The implemented screening program demonstrated significant cost-effectiveness by preventing costly PJI cases.
• This strategy offers a valuable approach to improving patient outcomes and optimizing resource allocation in arthroplasty surgery.