The aim of this prospective study was to determine the effect of screening for methicillin-resistant Staphylococcus aureus (MRSA), in patients undergoing total hip and knee replacements, on reducing hospital-acquired infections and the length of hospital stay. We included 395 patients admitted to the elective orthopaedic ward for hip and knee replacements (knee 210; hip 185) from 16 October 2000 to 15 October 2001. Group 1 included 164 admissions before 16 April 2001 when MRSA swabs were not compulsory. Group 2 included 231 admissions after 16 April 2001 when axillary, nasal and groin swabs had to be negative for MRSA. Four patients in group 1 had post-operative MRSA infection compared with none in group 2. The mean length of hospital stay decreased significantly from 10.43 days +/- SD 4.2 days in group 1 to 9.47 days +/- SD 2.6 days in group 2. There was a significant reduction in the incidence of hospital-acquired infections following the introduction of pre-admission screening.
Whilst the use of re-transfusion drains in primary knee arthroplasty has gained acceptance in reducing the requirement for donor blood products postoperatively, their use in total hip arthroplasty remains uncertain. Using two groups of 32 patients, a comparison was made between re-transfusion drains and vacuum drains in primary total hip arthroplasty in one centre and the requirement for postoperative donor blood. No statistically significant difference was found between the groups in terms of blood loss (p=0.51) or requirements for postoperative blood transfusion (p=0.12). The use of re-transfusion drains in primary total hip arthroplasty did not alter the rate of postoperative blood transfusion. (Hip International 2005; 15: 223-5).
Whilst the use of re-transfusion drains in primary knee arthroplasty has gained acceptance in reducing the requirement for donor blood products postoperatively, their use in total hip arthroplasty remains uncertain. Using two groups of 32 patients, a comparison was made between re-transfusion drains and vacuum drains in primary total hip arthroplasty in one centre and the requirement for postoperative donor blood. No statistically significant difference was found between the groups in terms of blood loss (p=0.51) or requirements for postoperative blood transfusion (p=0.12). The use of re-transfusion drains in primary total hip arthroplasty did not alter the rate of postoperative blood transfusion. (Hip International 2005; 15: 223-5).
Deep infection complicating arthroplasty surgery carries a heavy financial and emotional burden on any orthopaedic service. The cost of hospital acquired infection is estimated at 1 billion per year by the National Audit Office. Healthcare associated infection is an area currently under great scrutiny. The Alexandra Hospital, Redditch, has developed a dedicated elective orthopaedic ward free from methicillin-resistant Staphylococcus aureus (MRSA) that delivers high quality and high volume major joint replacement surgery through rigorous infection control. Between October 2001 and December 2002, the Alexandra Hospital had an infection rate of 0.21% for total knee replacements compared to the national rate of 2.1% p= 0.002 (CI 0.00005-0.01) The infection rate for total hip replacements was 1.31% compared to 3.8% nationwide. p= 0.01 (CI 0.004- 0.03). The total number of joint replacements performed per year, utilising the same number of elective beds, increased from 482 in 2001 to 629 in 2002. We believe that the MRSA screening policy and subsequent altered bed utilisation have contributed to lowering the rate of infection and improved efficiency. We have developed a safe, effective and efficient orthopaedic unit within the framework of an acute NHS trust. We believe the practical changes and modest investment that have been made within our department can be repeated in other units around the country with relative ease. (Hip International 2005; 15: 171-6).
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