Quality Improvement Reports

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

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7458.149 (Published 15 July 2004) Cite this as: BMJ 2004;329:149
  1. Leela C Biant (lcbiant{at}yahoo.com), specialist registrar in trauma and orthopaedic surgery1,
  2. E Louise Teare, consultant microbiologist1,
  3. William W Williams, consultant trauma and orthopaedic surgeon1,
  4. Jeremy D Tuite, consultant trauma and orthopaedic surgeon1
  1. 1 Broomfield Hospital, Chelmsford
  1. Correspondence to: L C Biant
  • Accepted 18 March 2004


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 methicillin resistant Staphylococcus aureus occurred in the first year after elective orthopaedic surgery was centralised to a district general hospital in Essex.

Design Prospective trial to establish whether ring fencing of elective orthopaedic beds and introduction of simple infection control measures has an effect on the rates of postoperative infections and number of patients treated.

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

Main measures for improvement Number of patients having joint replacement; number of all postoperative infections in the participant group; number of cases of methicillin resistant Staphylococcus aureus.

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

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

Lessons learnt The introduction of a ring fenced elective orthopaedic ward and simple infection control measures allowed 17% more patients to be treated and significantly reduced the incidence of all postoperative infections.


  • We thank J Dowell, M Taylor, and H Lyall, who operated on patients and participated in infection control regimens, and G Virich for help with data collection.

  • Contributors LCB coordinated the project, collected the data, wrote the paper, operated on patients, and participated in infection control regimens. ELT advised on setting up the study, devised the decontamination protocol, advised on infection control procedures, and devised treatment regimens for infected patients. WWW and JDT devised, set up, and coordinated the project, educated staff in infection control procedures, operated on patients, and advised on data collection. LCB is the guarantor.

  • Funding None.

  • Competing interests None declared.

  • Ethical approval Mid Essex NHS Trust ethics committee approved the study.

  • Accepted 18 March 2004
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