title: The role of pre-operative assessment and ringfencing of services in the control of methicillin resistant Staphlococcus aureus infection in orthopaedic patients.
abstract: BACKGROUND
  MRSA is a major economic and health issue internationally and as such is of particular importance in the appropriate management of orthopaedic patients. Bone, joint and implant infection can lead to unfavourable outcomes with a long protracted in hospital stay inevitable. The cost for the patient, the hospital and society are substantial.
  
  
  METHODS
  This study was a review of a prospectively maintained database from our unit over three time points from 2005 to 2007. At each time point a new infection control measure was implemented in an effort to reduce MRSA infections. Total rates of MRSA infection and colonisation in all orthopaedic patients were recorded, before and after separation of trauma and elective services, and after the introduction of a screening pre assessment clinic.
  
  
  RESULTS
  12259 orthopaedic patients were reviewed over the three years. The mean age of MRSA infected patients was 71. A higher proportion of female patients were infected than male patients. The mean length of stay for infected patients was 23.4 days. The rate of infection dropped from 0.49% in 2005 to 0.24%in 2007. After the introduction of these measures there was a substantial reduction in organ space and deep tissue infections.
  
  
  CONCLUSIONS
  The separation of emergency and elective orthopaedic services coupled with effective pre-operative screening has resulted in a significant reduction in MRSA infection despite an ever increasing prevalance.
authors.affiliation: Department of Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland. johncokelly@gmail.com
authors.forename: J C
authors.initials: JC
authors.lastname: Kelly
authors.forename: D E
authors.initials: DE
authors.lastname: O'Briain
authors.forename: R
authors.initials: R
authors.lastname: Walls
authors.forename: S I
authors.initials: SI
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: O'Rourke
authors.forename: J P
authors.initials: JP
authors.lastname: Mc Cabe
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007494:Ireland; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D019637:Orthopedic Procedures; D011300:Preoperative Care / Q000379:methods*; D015397:Program Evaluation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*