A COSTED REPLY TO THE FINANCIAL IMPLICATIONS OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (M.R.S.A.) IN ORTHOPAEDICS.

Abstract

PURPOSE: Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacterium we all encounter at some point in our lives. Recently, it has received significant amount of press coverage and has been a clinical and political concern. It has no predilection and affects both young and old alike. Control of MRSA spread is multi-factorial and current selective screening has become less useful. Hence, our orthopaedic department in a district general hospital setting has carried out an audit to find cost-effective ways to control the spread of MRSA.

METHOD: 686 patients were screened over a period of 3 months in 2005. Nasal and perineum swabs were taken within 24 hours of admission. Patients who developed MRSA infection in wounds were identified from hospital records. All hospital events (hardware) recorded were costed.

RESULTS : Of the 686 patients screened, 27 developed MRSA wound infections. 14 were new cases identified through screening. The costing for the period of 3 months for 10 patients (medical notes of 4 patients were not located) is £96 000. The total cost from MRSA infection when extrapolated is £384 000 per year. These figures are grossly underestimated as some surgical equipments were not costed.

DISCUSSION: We recommend 8 additional auxillary staff to cover 2 wards. This will enable nurse cohorting and cost £120 000 per year. Our department should have a positive pressure dressing room which cost £20 000 to build. This will ensure wounds are inspected in a clean controlled environment. A PCR rapid MRSA detection device plus staffing and culture media cost £149 000 per year. This should be used on emergency admissions. A cheaper detection kit can be used on elective patients which cost £12 000 per year. Hence total running cost will be £301 000 a year and subsequent years will cost £261 000. Compare that to £384 000 bearing in mind it was extrapolated from 3 months study on 14 newly identified MRSA positive orthopaedic patients who developed wound infection. Apart from that, we also recommend a holding bay for suspected cases whilst awaiting PCR results. Colonisers should be treated with Aquacept or Bactroban. At induction, teicoplanin and gentamicin iv should be used. MRSA patients should be nursed in side rooms. Beds should also be ring fenced.

CONCLUSION: It is much more cost-effective for a hospital trust to implement our recommendations to combat the spread of MRSA than to continue with the current practice.