title: A bundle that includes active surveillance, contact precaution for carriers, and cefazolin-based antimicrobial prophylaxis prevents methicillin-resistant Staphylococcus aureus infections in clean orthopedic surgery.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of orthopedic surgical site infections (SSIs). The aim of this study was to evaluate the effect of a bundle approach in the prevention of orthopedic MRSA SSIs.
  
  
  METHODS
  MRSA active surveillance and decolonization were performed preoperatively at our institution from July 2004 until 2007. In January 2008, a bundle approach comprising contact precautions for MRSA-positive patients and cefazolin-based antimicrobial prophylaxis (AMP) stewardship was implemented. Data on the prevalence of MRSA SSIs, antimicrobial use density, duration of AMP, and the use of an alcohol antiseptic agent (L/1,000 patient-days) were evaluated during 2 periods: July 2004-December 2007 (period A) and January 2008-December 2012 (period B).
  
  
  CONCLUSIONS
  The MRSA SSI rate during period B (0.97%; 19 out of 1,966) was significantly lower than that during period A (2.17%; 29 out of 1,333; P = .003). The infection rate correlated negatively with both the cefazolin antimicrobial use density (r = -0.76; P = .0002) and the use of an alcohol antiseptic agent (r = -0.68; P = .002).
  
  
  CONCLUSIONS
  An infection-prevention bundle consisting of contact precautions for carriers and AMP stewardship in addition to active surveillance was associated with a significant decrease in the incidence of orthopedic MRSA SSIs.
authors.affiliation: Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan; Department of Orthopaedic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. Electronic address: hidekik@m2.kufm.kagoshima-u.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawamura
authors.affiliation: Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Akari
authors.initials: A
authors.lastname: Shigemi
authors.affiliation: Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan; Division of Nursing, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Michiyo
authors.initials: M
authors.lastname: Orita
authors.affiliation: Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan; Division of Nursing, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Division of Nursing, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Nozima
authors.affiliation: Department of Orthopaedic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tominaga
authors.affiliation: The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Setoguchi
authors.affiliation: Department of Orthopaedic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Setsuro
authors.initials: S
authors.lastname: Komiya
authors.affiliation: Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tokuda
authors.affiliation: Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Nishi
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000494:pharmacology*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008875:Middle Aged; D019637:Orthopedic Procedures; D009985:Orthopedics; D015995:Prevalence; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016635:Universal Precautions
chemical_list: D000891:Anti-Infective Agents, Local; D002437:Cefazolin
keywords: MRSA; Nasal screening; Orthopedic surgical site infection; Transmission