Methicillin sensitive staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty
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Published on: February 9, 2011
Edward Jeans1, Richard Holleyman1, David Tate2
1Northumbria Healthcare NHS Foundation Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, NE63 9JJ, UK.
Aims:
Periprosthetic joint infection (PJI) is a catastrophic and potentially life threatening complication following arthroplasty. In addition to the resulting impact on patient morbidity and mortality, PJI is associated with significant financial cost, which is estimated at £21,937 per case. Methicillin sensitive staphylococcus aureus (MSSA) is a common isolate in PJI and colonisation is a proven risk factor for subsequent infection. The aims of this study were: (1) to determine if MSSA screening and decolonisation reduced MSSA PJI rate in primary joint replacement and (2) to determine cost effectiveness of such a screening program.
Methods:
Pre-operative screening for MSSA was introduced in our institution in 2010. All MSSA positive patients attending for elective arthroplasty were prescribed Octenisan body wash and nasal Bactroban for use 5 days prior to procedure, and five days after. Infection data was collected prospectively and compared with a control group from before.
Results:
Between 2007 and 2014, 12,910 primary arthroplasties (5917 hip, 6993 knee) were performed. There were 3593 in the pre-screening group and 9318 in the post-screening group. Pre-screening PJI MSSA rate was 0.75% which reduced to 0.25% post screening introduction (p < 0.0001). Overall PJI rate fell from 1.92% to 1.41% (p = 0.03). The screening program was most effective in MSSA prevention in total hip arthroplasty (3% to 1.5%, p = 0.002) and significant in the multivariate analysis. Following the introduction of the screening programme 47 PJIs were avoided, with a cost per infection prevented of £1893.
Conclusion:
The MSSA screening and eradication protocol used in our institution was effective at reducing rates of MSSA PJI. Furthermore, it resulted in significant savings when compared to the cost of prevented infections.
Insights
Implementing Methicillin-sensitive Staphylococcus aureus (MSSA) screening and decolonisation significantly reduced periprosthetic joint infection (PJI) rates in joint replacement surgery. This cost-effective program prevented infections and saved substantial healthcare costs.
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.
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