Aims: To assess the impact of ring fencing of elective orthopaedic arthroplasty patients on rates of post-operative infections including methicillin resistant staphlococ-cous aureus (MRSA). Method: For one year the rate of all postoperative infections in patients undergoing hip or knee arthroplasty were recorded (including chest, urinary, wound etc). Patients were treated using standard precautions against infection employed in most modern orthopaedic units. The elective ward was then ring fenced; admitting only elective patients who had clear swabs for infection taken in the community. Patients of other specialities and trauma were excluded. In addition barrier nursing and infection control measures were employed. The infection rate was then recorded for one year. Results: Prior to ring fencing there were 43 post-op infections in 417 patients (9 MRSA). In the ring fenced patients there were 15 infections in 488 patients (no MRSA). Conclusions: Ring fencing elective orthopaedic beds reduced overall infection rate, eradicated MRSA and allowed 17% more joint replacements to be performed. We recommend these precautions in all orthopaedic centres.

For one year (July 1999-July 2000), the rate of post-operative infection in patients undergoing joint arthroplasty was recorded (including wound, chest UTI etc). Standard precautions against infection used in most orthopaedic units in the UK were employed.

In July 2000 elective orthopaedic beds were ‘ring-fenced’. Only elective orthopaedic patients who had negative swabs for MRSA in the community were admitted. Eradication therapy was commenced in the community if appropriate. Trauma and other specialties’ patients were excluded.

In addition to standard precautions, nurses wore a disposable apron and gloves for each intervention. Antibacterial hand cleanser was installed by each bed, and staff expected to use it after each consultation. Doctors left jackets at the door and donned clean white coats for ward rounds. These were left on the ward and laundered daily. New cleaning regimes were adopted.

Pre ring-fencing, 417 joint replacements were performed and 60 patients were cancelled due to no bed. There were 43 post-op infections, 9 of which were MRSA. In the year post ring-fencing, 488 joint replacements were performed; there were no cancellations due to bed shortage. There were 15 post-op infections and no MRSA.

Eight patients swabbed positive for MRSA in the community, and were admitted after eradication therapy with no infections post-op.

We concluded that ‘ring-fencing’ of elective orthopaedic beds reduced cancellations, reduced the overall infection rate and abolished MRSA.

We have continued to ring-fence elective beds following this study, and recommend these precautions be employed in all units dealing with elective orthopaedic patients.