390. Effects of Care Bundle for Preventing Orthopedic Methicillin-resistant Staphylococcus aureus (MRSA) Surgical Site Infections (SSI)
Session: Poster Abstract Session: MRSA, MSSA, Enterococci
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • 390_IDW_LAYOUT.pdf (9.8 MB)
  • Background: MRSA is a common pathogen involved in orthopedic SSIs. Several studies have suggested that the care bundle approach including active surveillance culture(ASC), contact precautions, hand hygiene, and antimicrobial stewardship was effective in the prevention of nosocomial MRSA infections; however, the effects of care bundle for preventing orthopedic SSIs due to MRSA has rarely been reported. The aim of this study was to evaluate the effects of care bundle and to investigate appropriate prophylaxis for orthopedic MRSA SSI.

    Methods: The prophylaxis protocol for clean orthopedic surgery with ASC and nasal decolonization of MRSA has been implemented since July 2004 (the ASC period); since January 2008 (the bundle period), an additional protocol involving contact precautions, for those both colonized and infected with MRSA, and cefazolin-based antimicrobial prophylaxis has been implemented. We compared the prevalence of MRSA infections during the bundle period to that during the ASC period. Furthermore, we collected data regarding antimicrobial use density (AUD), use of alcohol antiseptic agent (L/1000 patient-days), and prevalence of MRSA infection from July 2004 through December 2012; the data were analyzed every 6 months.

    Results: The infection rate of non MRSA-carriers in the bundle period was significantly lower than that of non-carriers in the ASC period (0.49%, 16/3258 vs. 1.17%, 27/2315, P = .005). However, there was no difference between the prevalence of MRSA infections among carriers in the ASC period and that among carriers in the bundle period (3.19%, 3/94 vs. 4.44% 2/45, P = .52). There was a negative correlation between cefazolin AUD and the infection rate (r = −0.75, P = .0003). Additionally, a negative correlation was observed between the use of alcohol antiseptic agent and the infection rate (r = −0.66, P = .003).

    Conclusion: This study suggests that implementing the care bundle decreases the incidence of MRSA SSI among MRSA non-carriers. Identifying patients who were colonized by MRSA and implementing contact precaution prevented transmission and reduced the risk of infection. However, this protocol did not decrease the infection rates for MRSA carriers, and hence, another protocol including vancomycin prophylaxis may be important.

    Hideki Kawamura, MD, PhD1, Akari Shigemi, PhD1,2, Toyoyasu Koriyama, MT1,3, Kazuaki Matsumoto, PhD1,2, Michiyo Orita1, Setsuro Komiya, MD, PhD4, Koichi Tokuda, MD, PhD, MPH5 and Junichiro Nishi, MD, PhD1, (1)Division of Medical and Environmental Safety, Kagoshima University Hospital, Kagoshima, Japan, (2)Department of Clinical Pharmacy and Pharmacology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan, (3)Division of Clinical Laboratory, Kagoshima University Hospital, Kagoshima, Japan, (4)Department of Orthopaedic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan, (5)Department of Infection Control and Laboratory Diagnostics, Tohoku University Graduate School of Medicine, Sendai, Japan


    H. Kawamura, None

    A. Shigemi, None

    T. Koriyama, None

    K. Matsumoto, None

    M. Orita, None

    S. Komiya, None

    K. Tokuda, None

    J. Nishi, None

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