METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS ON AN ELECTIVE ORTHOPAEDIC WARD: CAN IT BE CONTROLLED?

Abstract

We set out to determine whether modification of ward facilities and working practices can prevent MRSA infection on an elective Orthopaedic ward, and whether these changes are cost effective.

Following a cluster of 3 cases of acute, deep MRSA infections in arthroplasty patients in early 1999, a review of elective orthopaedic facilities was carried out. The problems identified on the elective Orthopaedic ward were:

1. inadequate toilet/washing facilities

2. large numbers of non-orthopaedic outliers

3. inadequate hand washing facilities

4. poor ventilation

The following changes were made:

Ward

1. reduction of beds from 36 to original complement of 30

2. refurbishment and increase in number of toilet/washing facilities

3. hand washing facilities in all bays

4. ventilation improved throughout the ward

Staff

1. regular MRSA screening of all staff

2. movement of staff between wards discouraged (eg. physiotherapists)

3. hand washing ethos encouraged

Practices

1. all patients must have a negative MRSA screen before admission

2. elective activity ceases if non-MRSA screened patients are admitted. Ward is then closed for 24 hours and ‘deep cleaned’

There has been only one further case of MRSA wound infection in the 1300 major cases that have been through the ward in the last 3 years. This patient spent the first 48 hours post-operatively on the ITU, where MRSA colonisation was widespread.

We performed a cost analysis exercise on the request of our Microbiology department, as they felt that the routine swabbing of so many patients was not cost effective.

We analysed the year 2000 in which 1783 patients were screened for MRSA at a total cost of £24,962 (£14.00 per screen).

A literature search gave us the estimated cost of an MRSA infected arthroplasty being in the order of £31,568, which compares favourably with the total yearly cost of our screening program.

With appropriate facilities and modification of working practices, MRSA infection can be controlled on an elective Orthopaedic ward.

The total yearly cost of our screening programme is less than the potential cost of a single MRSA infected arthroplasty.

The changes made to our working practice and the introduction of our screening programme have been found to be both clinically and cost effective.