Eradication of methicillin resistant Staphylococcus aureus by "ring fencing" of elective orthopaedic beds

doi:10.1136/bmj.329.7458.149

BMJ 2004;329:149-151 (17 July), doi:10.1136/bmj.329.7458.149

Quality improvement report

Eradication of methicillin resistant Staphylococcus aureus by "ring fencing" of elective orthopaedic beds

Leela C Biant, specialist registrar in trauma and orthopaedic surgery¹, E Louise Teare, consultant microbiologist¹, William W Williams, consultant trauma and orthopaedic surgeon¹, Jeremy D Tuite, consultant trauma and orthopaedic surgeon¹

¹ Broomfield Hospital, Chelmsford

Correspondence to: L C Biant lcbiant{at}yahoo.com

Problem Deep infection after joint arthroplasty can be catastrophic,leading to further surgery, loss of the prosthesis, disability,and risk of mortality. Twenty nine new cases of methicillinresistant Staphylococcus aureus occurred in the first year afterelective orthopaedic surgery was centralised to a district generalhospital in Essex.

Design Prospective trial to establish whether ring fencing ofelective orthopaedic beds and introduction of simple infectioncontrol measures has an effect on the rates of postoperativeinfections and number of patients treated.

Participants and setting All patients undergoing primary hipor knee replacement in a district general hospital in Essex,England, between July 1999 and July 2001.

Main measures for improvement Number of patients having jointreplacement; number of all postoperative infections in the participantgroup; number of cases of methicillin resistant Staphylococcusaureus.

Strategies for change Ring fencing of the elective orthopaedicward and introduction of simple infection control measures.

Effects of change The incidence of all postoperative infectionsdecreased from 43/417 to 15/488 (P < 0.0001), with no newcases of methicillin resistant Staphylococcus aureus.

Lessons learnt The introduction of a ring fenced elective orthopaedicward and simple infection control measures allowed 17% morepatients to be treated and significantly reduced the incidenceof all postoperative infections.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to StumbleUpon StumbleUpon Add to Technorati Technorati What's this?

Relevant Articles

Improving surveillance of MRSA bacteraemia: Georgia Duckworth and Andr Charlett
BMJ 2005 331: 976-977. [Extract] [Full Text] [PDF]

Eradication of MRSA by "ring fencing" orthopaedic beds: Stand alone orthopaedic units may be way forward in reducing MRSA: Graham C Cheung and Ashutosh Acharya
BMJ 2004 329: 572. [Extract] [Full Text]

Ring fencing reduces hospital infection
BMJ 2004 329: 0. [Full Text]

This article has been cited by other articles:

Fascia, D. T. M., Singanayagam, A., Keating, J. F. (2009). Methicillin-resistant Staphylococcus aureus in orthopaedic trauma: IDENTIFICATION OF RISK FACTORS AS A STRATEGY FOR CONTROL OF INFECTION. J Bone Joint Surg Br 91-B: 249-252 [Abstract] [Full text]
Patel, A., Calfee, R. P., Plante, M., Fischer, S. A., Arcand, N., Born, C. (2008). Methicillin-resistant Staphylococcus aureus in orthopaedic surgery. J Bone Joint Surg Br 90-B: 1401-1406 [Abstract] [Full text]
Harbarth, S., Fankhauser, C., Schrenzel, J., Christenson, J., Gervaz, P., Bandiera-Clerc, C., Renzi, G., Vernaz, N., Sax, H., Pittet, D. (2008). Universal Screening for Methicillin-Resistant Staphylococcus aureus at Hospital Admission and Nosocomial Infection in Surgical Patients. JAMA 299: 1149-1157 [Abstract] [Full text]
Phillips, J. E., Crane, T. P., Noy, M., Elliott, T. S. J., Grimer, R. J. (2006). The incidence of deep prosthetic infections in a specialist orthopaedic hospital: A 15-YEAR PROSPECTIVE SURVEY. J Bone Joint Surg Br 88-B: 943-948 [Abstract] [Full text]
Roche, S. J., Fitzgerald, D., O'Rourke, A., McCabe, J. P. (2006). Methicillin-resistant Staphylococcus aureus in an Irish orthopaedic centre: A FIVE-YEAR ANALYSIS. J Bone Joint Surg Br 88-B: 807-811 [Abstract] [Full text]
Duckworth, G., Charlett, A. (2005). Improving surveillance of MRSA bacteraemia. BMJ 331: 976-977 [Full text]
Giannoudis, P. V., Parker, J., Wilcox, M. H. (2005). Methicillin-resistant Staphylococcus aureus in trauma and orthopaedic practice. J Bone Joint Surg Br 87-B: 749-754 [Full text]
Watts, G. (2004). Golden rules. BMJ 329: 538-539 [Full text]
Cheung, G. C, Acharya, A. (2004). Eradication of MRSA by "ring fencing" orthopaedic beds: Stand alone orthopaedic units may be way forward in reducing MRSA. BMJ 329: 572-572 [Full text]

Rapid Responses:

Read all Rapid Responses

Antibiotic prescribing control should not be underestimated: Vicky V Gereis
bmj.com, 18 Jul 2004 [Full text]
Those halcyon days...: John F Bolton
bmj.com, 19 Jul 2004 [Full text]
The return of stand alone orthopaedic units: Graham C Cheung, et al.
bmj.com, 24 Jul 2004 [Full text]
Reducing MRSA on orthopaedic wards: Amit Datta, et al.
bmj.com, 25 Jul 2004 [Full text]
Re: Reducing MRSA on orthopaedic wards: Sydney J. Bush PhD. DOpt.. (IOSc. London), et al.
bmj.com, 30 Jul 2004 [Full text]
Misleading titles: Keith C Judkins, et al.
bmj.com, 12 Aug 2004 [Full text]
MRSA colonised elective orthopaedic patients and where they could fit in in"ring fenced" wards.: Mark C Norris, et al.
bmj.com, 13 Aug 2004 [Full text]
Re: Reducing MRSA on orthopaedic wards: Dr. Sydney J. Bush PhD., DOpt. (IOSc. London)
bmj.com, 29 Nov 2004 [Full text]