Methicillin sensitive staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty

Jeans, Edward; Holleyman, Richard; Tate, David F.; Reed, Mike; Malviya, Ajay

doi:10.1016/j.jinf.2018.05.012

Cited by 34 publications

(41 citation statements)

References 24 publications

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“…[38] Ultimately, £1893 was saved per case by decreasing the PJI rate. [38] Similarly, Barbero Allende et al (2015) showed that the identical decolonization strategy to the one employed in our study resulted in an amelioration of the rate of SSI by 40.7%. [33] There were several major weaknesses identified in evaluation of the study.…”

Section: Discussionsupporting

confidence: 73%

“…The decolonization rate using mupirocin and chlorhexidine was 94.74% in this study and is in keeping (2018) showed that eradication therapy with mupirocin ointment in patients awaiting TJA was most efficacious in patients colonized with MSSA rather than MRSA. [38] Barbero Allende et al (2015) showed that the identical strategy to the one employed in our study resulted in a 98% decolonization rate. [33] The use of intranasal mupirocin and full body chlorhexidine wash yielded good results and supports the combination of both treatment modalities.…”

Section: Discussionsupporting

confidence: 51%

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Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

Pietrzak

Maharaj

Mokete

2020

Preprint

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Background: Periprosthetic joint infections are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty. Staphylococcus aureus colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in Staphylococcus aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of Staphylococcus aureus colonization in patients awaiting Total Joint Arthroplasty in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for Staphylococcus aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher's exact tests, and chi square analyses.Results: The overall prevalence of Methicillin Sensitive Staphylococcus aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant Staphylococcus aureus . Nasal swabs returned a yield of 81.6%(n=31), with groin swabs and axillary swabs at 39.5% (n=15) and28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the Staphylococcus aureuscolonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60-and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of Staphylococcus aureus colonization in patients undergoing elective TotalJoint Arthroplasty in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 51%

Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

Pietrzak

Maharaj

Mokete

2020

Preprint

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“…Similarly, a relatively simple programme for preoperative MSSA screening and decolonisation has also been successfully implemented in an English NHS Trust for elective hip and knee arthroplasty patients. (37) This resulted in a significant reduction in the rate of MSSA prosthetic joint infection (0.75 v 0.25% p<0.0001). This programme is reported to have prevented 47 MSSA prosthetic infections and cost £1,893 per infection avoided, each of which would have cost tens of thousands to treat.…”

Section: Discussionmentioning

confidence: 95%

“…36In a retrospective cohort study, performed by Northumbria Healthcare NHS Foundation Trust, a decrease in MSSA infection rate from 0.75% (28/3593) to 0.25% (23/9318) was found following the adoption of an MSSA decolonisation programme for carriers of MSSA in elective joint replacement. (37) To detect a difference from 0.75% to 0.25% would require 6246 patients in an individually randomised trial with 80% power. Between October 2015 and September 2016, 123,861 hip and knee operations were undertaken in 139 hospital Trusts (average 891).…”

Section: Sample Sizementioning

confidence: 99%

“…Summary of how elements of IHI BSC will be applied to the QIST trial Selection procedure if more than 40 interested Trusts identified All team members to be healthcare professionals and idea GCP trained but this is not essential is ripe for improvement: existing knowledge is sound but not widely used, better results have been demonstrated in real-world settings, and current defect rates affect many patients somewhat, or at least a few patients profoundly. "(4) For this project the two initiatives have demonstrated real-world improvements in reducing SSI and anaemia related complications, both of which have profound effects on patients and their outcomes (28,37). However, these protocols are not widely used across the NHS.For this study, calls for interested centers will be made via the British Orthopaedic Association (BOA) and via the Sponsor, Northumbria Healthcare NHS Foundation Trust, with the help of NHS Improvement.…”

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confidence: 99%

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Scaling Up Quality Improvement for Surgical Teams (QIST) - avoiding surgical site infection and anaemia at the time of surgery: protocol for a cluster randomised controlled trial

Scrimshire¹,

Booth

Fairhurst

et al. 2019

Preprint

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Background: Measures shown to improve outcomes for patients often fail to be adopted into routine practice in the NHS. The Institute for Health Improvement Breakthrough Series Collaborative (BSC) model is designed to support implementation at scale. This trial aims to assess the effectiveness and cost-effectivenessof quality improvement collaboratives based on the BSC method for introducing service improvements at scale in the NHS. Methods: Forty Trusts will be randomised (1:1) to introduce one of two protocols already shown to improve outcomes in patients undergoing elective total hip and knee replacement surgery. The intervention is improvement collaboratives based on the BSC model, a learning system that brings together a large number of teams to seek improvement focused on a proven intervention. Collaboratives aim to deliver at scale, maximise local engagement and leadership and are designed to build capacity, enable learning and prepare for sustainability. Collaboratives involve learning sessions, action periods, and a summative congress. Trusts will be supported to introduce either: decolonisation for MSSA to reduce post-operative infection (QIST:Infection), or an anaemia optimisation programme to reduce peri-operative blood transfusions (QIST:Anaemia). Trusts will continue with their usual practice for whichever protocol they are not introducing. Anonymised data related to both infection and anaemia outcomes for patients undergoing hip or knee arthroplasty at all sites will mean the two groups act as controls for each other. The primary outcome for the QIST: Infection collaborative is deep MSSA surgical site infection within 90 days of surgery, and for the QIST: Anaemia collaborative is blood transfusion within 7 days of surgery. Patient-level secondary outcomes include length of hospital stay and re-admission, which will also inform the economic costings. Qualitative interviews will evaluate the support provided to teams. Discussion: The scale of this trial brings considerable challenges and potential barriers to delivery. Anticipated challenges relate to recruiting and sustaining up to 40 organisations, each with their own culture and context. This complex project with multiple stakeholders across a large geography will be managed by experienced senior-level project leaders with a proven track record in advanced project management. The team will ensure effective project governance and communications.

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Preoperative Management: Staphylococcus aureus Decolonisation

Hamilton

Alvand

Price

2021

Infection in Knee Replacement

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Methicillin sensitive staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty

Cited by 34 publications

References 24 publications

Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

Scaling Up Quality Improvement for Surgical Teams (QIST) - avoiding surgical site infection and anaemia at the time of surgery: protocol for a cluster randomised controlled trial

Preoperative Management: Staphylococcus aureus Decolonisation

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