ERADICATION OF MRSA AND REDUCTION OF EARLY INFECTION RATES IN PRIMARY HIP AND KNEE ARTHROPLASTY WITH THE INTRODUCTION OF ‘RINGFENCING’ IN A DISTRICT GENERAL HOSPITAL

Abstract

Introduction: Arthroplasty infection is both devastating for the individual and expensive for the healthcare system. Many measures are taken during a patient’s pathway to try and prevent this complication. Ring fencing beds is perceived to be beneficial in this struggle, but due to complexity it is difficult to identify the effect of ringfencing on infection rates; furthermore to date there is little published data to support it’s use. We present our data of infection rates before and after the introduction of a ringfence policy. The antibiotic prophylaxis regime was the only other variable to change.

Methods: Two 24 month periods were selected before and after the introduction of a strict ringfence policy. In the first period (pre-ringfence period) patients were MRSA screened pre operatively but not placed in a ward with a ringfence policy. Cefuroxime was administered as prophylaxis. In the second period (ringfence period) screened patients were only admitted to a ward where all patients were known to be MRSA free. Tei-coplanin prophylaxis was administered. The hospital building, operating theatres, implants and surgeons were the same for both groups. Infections were identified retrospectively by analysing clinical notes and laboratory results. Statistical analysis was performed using Fisher’s exact test.

Results: Both patient groups had similar demographics. More joints were performed in the ringfence period compared to the pre-ringfence period (870 vs 590), with a shorter average length of stay (7 vs 11 days). In the ring-fencing period there was an overall significant reduction in early infections (1.26% vs 3.05%, p< 0.05). MRSA was eliminated (2.2% vs 0%, p< 0.05)

Conclusions: A combination of these two interventions led to a significant reduction in early infection rates and the elimination of MRSA in primary joint arthroplasty patients, even though the exact contribution of each intervention could not be established.