Abstract
The aim of this prospective study was to determine the effect of screening for methicillin-resistant Staphylococcus aureus (MRSA), in patients undergoing total hip and knee replacements, on reducing hospital-acquired infections and the length of hospital stay. We included 395 patients admitted to the elective orthopaedic ward for hip and knee replacements (knee 210; hip 185) from 16 October 2000 to 15 October 2001. Group 1 included 164 admissions before 16 April 2001 when MRSA swabs were not compulsory. Group 2 included 231 admissions after 16 April 2001 when axillary, nasal and groin swabs had to be negative for MRSA. Four patients in group 1 had post-operative MRSA infection compared with none in group 2. The mean length of hospital stay decreased significantly from 10.43 days ± SD 4.2 days in group 1 to 9.47 days ± SD 2.6 days in group 2. There was a significant reduction in the incidence of hospital-acquired infections following the introduction of pre-admission screening.
Résumé
Le but de cette étude prospective était de déterminer l’effet du dépistage du Staphylocoque Aureus Méthicilline Résistant (MRSA) chez des patients devant subir une prothèse de hanche ou de genou, sur la réduction des infections nosocomiales et la durée du séjour hospitalier. Nous avons inclus 395 malades admis pour remplacement prothétique de la hanche et du genou (genou 210 / Hanche 185) du 16 octobre 2000 au 15 octobre 2001. Le groupe 1 a inclus 164 admissions avant le 16 avril 2001 quand les écouvillonnages MRSA n’étaient pas obligatoires. Le groupe 2 a inclus 231 admissions après le 16 avril 2001 quand l’écouvillonnage axillaire, nasal et inguinal devait être négatif pour le MRSA. Cinq malades du groupe 1 ont eu une infection MRSA postopératoire , comparé à l’absence d’infection dans le groupe 2. La durée moyenne de séjour a diminué de 10.43 jours (±SD 4.2 j) dans le groupe 1 à 9.47 jours (±SD 2.6 j ) dans le groupe 2. Il y avait une réduction significative de la fréquence des infections acquises à l’hôpital grâce au dépistage avant l’admission.
Full Text
The Full Text of this article is available as a PDF (78.7 KB).
References
- 1.Beaujean DJ, Weersink AJ, Blok HE, Frenay HM, Verhoef J. Determining risk factors for methicillin-resistant Staphylococcus aureus carriage after discharge from hospital. J Hosp Infect. 1999;42:213–218. doi: 10.1053/jhin.1999.0585. [DOI] [PubMed] [Google Scholar]
- 2.Critelli L, Black PN. Preadmission discharge planning shortens LOS (length of stay) for elective orthopedic surgery. Disch Plann Update. 1993;13:18–21. [PubMed] [Google Scholar]
- 3.Lucas-Villarrubia JC, Lopez-Franco M, Granizo JJ, Lucas-Garcia JC, Gomez-Barrena E. Strategy to control methicillin-resistant Staphylococcus aureus post-operative infection in orthopaedic surgery. Int Orthop. 2004;28:16–20. doi: 10.1007/s00264-003-0460-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Engemann JJ, Carmeli Y, Cosgrove SE, Fowler VG, Bronstein MZ, Trivette SL, Briggs JP, Sexton DJ, Kaye KS. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis. 2003;36:592–598. doi: 10.1086/367653. [DOI] [PubMed] [Google Scholar]
- 5.Fruhauf G, Heuck D, Tomaschewski R, Witte W, Langer S, Bretschneider M. Outbreak of infection with methicillin-resistant Staphylococcus aureus (MRSA) in an orthopedic septic care unit-measures for eradication and subsequent colonization studies. Z Orthop Ihre Grenzgeb. 1996;134:273–282. doi: 10.1055/s-2008-1039761. [DOI] [PubMed] [Google Scholar]
- 6.Garrouste-Orgeas M, Timsit JF, Kallel H, Ben Ali A, Dumay MF, Paoli B, Misset B, Carlet J. Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol. 2001;22:687–692. doi: 10.1086/501846. [DOI] [PubMed] [Google Scholar]
- 7.Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis. 2003;36:281–285. doi: 10.1086/345955. [DOI] [PubMed] [Google Scholar]
- 8.James LA, Sookhan N, Subar D. Timing of operative intervention in the management of acutely fractured ankles and the cost implications. Injury. 2001;32:469–472. doi: 10.1016/S0020-1383(00)00254-0. [DOI] [PubMed] [Google Scholar]
- 9.Khan OA, Weston VC, Scammell BE. Methicillin-resistant Staphylococcus aureus incidence and outcome in patients with neck of femur fractures. J Hosp Infect. 2002;51:185–188. doi: 10.1053/jhin.2002.1257. [DOI] [PubMed] [Google Scholar]
- 10.Kim S, Losina E, Solomon DH, Wright J, Katz JN. Effectiveness of clinical pathways for total knee and total hip arthroplasty: literature review. J Arthroplasty. 2003;18:69–74. doi: 10.1054/arth.2003.50030. [DOI] [PubMed] [Google Scholar]
- 11.Konig DP, Randerath O, Hackenbroch MH. Nosocomial infections with methicillin-resistant Staphylococcus aureus (MRSA) and epidermidis (MRSE) strains. Their importance, prophylaxis and therapy in orthopedic surgery. Unfallchirurg. 1999;102:324–328. doi: 10.1007/s001130050410. [DOI] [PubMed] [Google Scholar]
- 12.Kotilainen P, Routamaa M, Peltonen R, Oksi J, Rintala E, Meurman O, Lehtonen OP, Eerola E, Salmenlinna S, Vuopio-Varkila J, Rossi T. Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis. 2003;9:169–175. doi: 10.3201/eid0902.020233. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Liebergall M, Soskolne V, Mattan Y, Feder N, Segal D, Spira S, Schneidman G, Stern Z, Israeli A. Preadmission screening of patients scheduled for hip and knee replacement: impact on length of stay. Clin Perform Qual Health Care. 1999;7:17–22. [PubMed] [Google Scholar]
- 14.Said-Salim B, Mathema B, Kreiswirth BN. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging pathogen. Infect Control Hosp Epidemiol. 2003;24:451–455. doi: 10.1086/502231. [DOI] [PubMed] [Google Scholar]
- 15.Samad A, Banerjee D, Carbarns N, Ghosh S. Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital. J Hosp Infect. 2002;51:43–46. doi: 10.1053/jhin.2002.1182. [DOI] [PubMed] [Google Scholar]
- 16.Tai CC, Nirvani AA, Holmes A, Hughes SP. Methicillin-resistant Staphylococcus aureus in orthopaedic surgery. Int Orthop. 2004;28:32–35. doi: 10.1007/s00264-003-0505-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Talon D, Vichard P, Muller A, Bertin M, Jeunet L, Bertrand X. Modelling the usefulness of a dedicated cohort facility to prevent the dissemination of MRSA. J Hosp Infect. 2003;54:57–62. doi: 10.1016/S0195-6701(03)00086-0. [DOI] [PubMed] [Google Scholar]
- 18.Wilcox MH, Hall J, Pike H, Templeton PA, Fawley WN, Parnell P, Verity P. Use of perioperative mupirocin to prevent methicillin-resistant Staphylococcus aureus (MRSA) orthopaedic surgical site infections. J Hosp Infect. 2003;54:196–201. doi: 10.1016/S0195-6701(03)00147-6. [DOI] [PubMed] [Google Scholar]