Abstract
MRSA infections are a current concern in the elderly orthopaedic patient, with colonisation rates of between 417% reported in these patient groups. In our institution there has been concern regarding MRSA surgical site infection and cross contamination of elective and emergency patients. This prompted the unit to consider a screening programme to identify MRSA carriers. We undertook the following project to assess the feasibility and effectiveness of implementing such a screening programme.
The aim was to to ascertain the incidence of colonisation with MRSA, rate of wound infection and associated risk factors in patients admitted with a fractured proximal femur.
This was a prospective, blinded case series of 100 consecutive patients admitted to the trauma ward with a fractured proximal femur. Three swabs (axilla, nasal and perineum) were taken within 24 hours of admission. Data from each patient was collated and each patient was followed until discharge to assess for surgical site infection.
The age range was 60–97 years. 26% were admitted from institutional care. Four patients were colonised with MRSA on admission. An association was seen between patients colonised on admission and long term or recent residence in institutional care. One of these patients went on to develop colonisation of the surgical wound however this did not lead to surgical site infection and the patient was successfully treated with MRSA eradication therapy only. In these 4 patients all wounds healed satisfactorily with no evidence of infection.
While MRSA continues to be a growing concern in the press we found that rates of colonisation and subsequent infection were not high. There were no documented cases of MRSA wound infection in colonised individuals. Given the cost to detect these low levels of colonisation we do not feel that a screening regime would be cost effective or justified.
Correspondence should be addressed to Major M Butler RAMC, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon.
Correspondence should be addressed to Major M Butler, CSOS, Institute of Naval Medicine, Crescent Road, Alverstoke, Hants PO12 2D
