Program Schedule

Occurrence of Methicillin-Resistant Staphylococcus aureus (MRSA) Surgical Site Infections (SSIs) of Total Knee and Total Hip Arthroplasty (TKA and THA) Procedures within Veterans Health Administration Medical Centers

Session: Poster Abstract Session: MRSA and VRE
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: TKAs and THAs are typically clean surgeries.  Though rare, they can become infected post-surgically.  Staphylococcus aureus is a common etiologic agent for causing SSI in these surgeries.   Infection with MRSA has been contributing to larger percentage of these infections.  VA’s MRSA Prevention Initiative started early in 2007 and was completely operational by October 2007. During this time, no specific system-wide guidelines for routine pre-operative decolonization practices have been implemented.  We analyzed data in association with VA’s MRSA Prevention Initiative to see if there was a decrease in MRSA SSIs associated with TKAs and THAs.

Methods: From 2008 through 2012, TKA/THA surgeries done and infections with MRSA in these surgeries have been tracked up to 1-year post surgical implantation of the artificial joint.  Poisson regression of combined TKA/THA annual rates was performed for the 5-year period for trend.

Results: From among its 151 medical center sites, VA had 98 which performed one or more TKAs/THAs during the analysis period.  55,454 TKAs/THAs were reported from VAMCs.  Of those 55,454, 336 (0.61%) had an SSI within 1 year of the surgery.  The table below indicates annual rates from the analysis.


MRSA-associated TKA/THA SSI rates 1 year after implantation


95% LCL

95% UCL





















P=0.0004 for decrease by Poisson regression evaluating all sites annually over time

*FY=Federal Fiscal Year (running from Oct 1 through Sept 30).

Conclusion: Decrease of mean MRSA-associated TKA/THA SSI rates by over 40% was seen between 2008 and 2012, in temporal association with the MRSA National Prevention Initiative.

Stephen Kralovic, MD, MPH1,2,3, Martin Evans, MD4,5, Loretta Simbartl, MS1, Judith Whitlock, RN, MSN, APRN4, Marla Clifton, RN, MSN, CIC1, Rajiv Jain, MD6 and Gary Roselle, MD1,2,3, (1)National Infectious Diseases Service, Department of Veterans Affairs Central Office, Cincinnati, OH, (2)Division of Infectious Diseases, University of Cincinnati, Cincinnati, OH, (3)Cincinnati VA Medical Center, Cincinnati, OH, (4)Department of Veterans Affairs Central Office National Infectious Diseases Service MRSA/MDRO Prevention Office, Lexington, KY, (5)Lexington VA Medical Center, Lexington, KY, (6)Department of Veterans Affairs, Veterans Health Administration Central Office Patient Care Services, Washington, DC


S. Kralovic, None

M. Evans, None

L. Simbartl, None

J. Whitlock, None

M. Clifton, None

R. Jain, None

G. Roselle, None

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