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

• Published in: American journal of infection control Vol. 44; no. 2; pp. 210 - 214
• Main Authors: Kawamura, Hideki, MD, PhD, Matsumoto, Kazuaki, PhD, Shigemi, Akari, MSc, Orita, Michiyo, MSc, Nakagawa, Aya, RN, Nozima, Satoko, RN, Tominaga, Hiroyuki, MD, PhD, Setoguchi, Takao, MD, PhD, Komiya, Setsuro, MD, PhD, Tokuda, Koichi, MD, PhD, MPH, Nishi, Junichiro, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016; Mosby-Year Book, Inc
• Subjects: Adult; Aged; Anti-Infective Agents, Local - pharmacology; Antibiotic Prophylaxis; Antimicrobial agents; Cefazolin - pharmacology; Cross Infection - microbiology; Cross Infection - prevention & control; Drug resistance; Female; Humans; Infection Control; Infectious Disease; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus - drug effects; Middle Aged; MRSA; Nasal screening; Orthopedic Procedures; Orthopedic surgical site infection; Orthopedics; Prevalence; Preventive medicine; Staphylococcal Infections - microbiology; Staphylococcal Infections - prevention & control; Staphylococcus infections; Surgical Wound Infection - prevention & control; Surveillance; Transmission; Universal Precautions; Orthopedic surgical site infection; Nasal screening; MRSA; Transmission
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2015.09.014

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. Material and 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). Results and Discussion 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.