Lessons learnt
Ring fencing of elective orthopaedic beds and simple
infection control measures significantly reduced the
incidence of postoperative infections in patients
undergoing joint arthroplasty, and MRSA was eradicated.
As a consequence of fewer complications and
more predictable bed occupancy, as well as not having
beds blocked for long periods by trauma patients and
non-orthopaedic patients, we were able to do 17%
more joint arthroplasties without increasing the
number of operating lists, beds, or surgeons.
Staff, patients, and visitors had to undergo a major
change in culture in order to implement the changes.
The senior medical and nursing staff acted as role
models in the implementation of new policy, as
described by Ching and Seto.3
We acknowledge that the reduction in infection
rate was achieved by several factors: ring fencing, simple
infection control measures, and reducing the
number of agency staff to a minimum. However, the
model as a whole shows important and significant
results.
This work showed an increase in healthcare
associated infection, including MRSA, in an elective
orthopaedic ward containing patients from other
specialties, including trauma. The importance of the
theatre environment on joint arthroplasty has been
understood for many years; we have shown that the
ward environment is also highly important in the rate
of infection in patients having joint arthroplasty.
Plowman et al suggested that hospital acquired
infection increases patients' length of stay (up to 11
days per case) and the cost of treatment (£2917 per
case).4 Although infection in joint replacement
surgery may be caused by direct contamination at the
time of surgery, the ...