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

AIMS: Periprosthetic joint infection (PJI) is a catastrophic and potentially life threatening complication following arthroplasty. In addition to the resulting impact on patient morbidity and mortality, PJI is associated with significant financial cost, which is estimated at £21,937 per case. Methicillin sensitive staphylococcus aureus (MSSA) is a common isolate in PJI and colonisation is a proven risk factor for subsequent infection. The aims of this study were: (1) to determine if MSSA screening and decolonisation reduced MSSA PJI rate in primary joint replacement and (2) to determine cost effectiveness of such a screening program.

METHODS: Pre-operative screening for MSSA was introduced in our institution in 2010. All MSSA positive patients attending for elective arthroplasty were prescribed Octenisan body wash and nasal Bactroban for use 5 days prior to procedure, and five days after. Infection data was collected prospectively and compared with a control group from before.

RESULTS: Between 2007 and 2014, 12,910 primary arthroplasties (5917 hip, 6993 knee) were performed. There were 3593 in the pre-screening group and 9318 in the post-screening group. Pre-screening PJI MSSA rate was 0.75% which reduced to 0.25% post screening introduction (p < 0.0001). Overall PJI rate fell from 1.92% to 1.41% (p = 0.03). The screening program was most effective in MSSA prevention in total hip arthroplasty (3% to 1.5%, p = 0.002) and significant in the multivariate analysis. Following the introduction of the screening programme 47 PJIs were avoided, with a cost per infection prevented of £1893.

CONCLUSION: The MSSA screening and eradication protocol used in our institution was effective at reducing rates of MSSA PJI. Furthermore, it resulted in significant savings when compared to the cost of prevented infections.