Skip to main content

Advertisement

SpringerLink
Log in

The hip fracture best practice tariff: early surgery and the implications for MRSA screening and antibiotic prophylaxis

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

In April 2010, the Department of Health introduced the hip fracture best practice. Among the clinical criteria required to earn remuneration is surgery within 36 h of admission. However, early surgery may mean that methicillin-resistant Staphylococcus aureus (MRSA) colonisation status is not known before surgery, and therefore, appropriate antibiotic prophylaxis may not be administered. In view of this, our department’s policy is to administer an additional dose of teicoplanin to patients with unknown MRSA status along with routine antimicrobial prophylaxis.

Aim

The purpose of this study was to provide a safe and effective antimicrobial prophylaxis for hip fracture patients.

Methods

We prospectively collected details of demographics and antimicrobial prophylaxis for all patients admitted with a hip fracture in November 2011. This was repeated in February 2012 after an educational and advertising drive to improve compliance with departmental antimicrobial policy. Microbiology results were obtained from the hospital microbiology database. A cost-benefit analysis was undertaken to assess this regime.

Results

A total of 144 hip fracture patients were admitted during the 2 months. The average admission to surgery time was 32 h, and the average MRSA swab processing time was 35 h. 86 % of patients reached theatre with unknown MRSA status. Compliance with the departmental antimicrobial policy improved from 25 % in November 2011 to 76 % in February 2012. Potential savings of £40,000 were calculated.

Conclusion

With best practice tariff resulting in 86 % of patients reaching theatre with unknown MRSA status, we advocate an additional single dose of teicoplanin to cover against possible MRSA colonisation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Department of Health (2010) Best Practice Tariff. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/NHSFinancialReforms/DH_105080. Accessed 31 October 2012

  2. Uzoigwe CE, Burnand HG, Cheesman CL, Aghedo DO, Faizi M, Middleton RG (2013) Early and ultra-early surgery in hip fracture patients improves survival. Injury 44:726–729

    Article  PubMed  Google Scholar 

  3. Novack V, Jotkowitz, Etzion O, Porath A (2007) Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Health Care 19:170–176

    Article  PubMed  Google Scholar 

  4. Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489

    Article  PubMed  Google Scholar 

  5. Hughes C, Smith M, Tunney M, Bradley MC (2011) Infection control strategies for preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database Syst Rev 12:CD006354

  6. Eseonu KC, Middleton SD, Eseonu CC (2011) A retrospective study of risk factors for poor outcomes in methicillin-resistant Staphylococcus aureus (MRSA) infection in surgical patients. J Orthop Surg Res 6:25

    Article  PubMed Central  PubMed  Google Scholar 

  7. Nixon M, Jackson B, Varghese P, Jenkins D, Taylor G (2006) Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control. J Bone Joint Surg Br 88:812–817

    Article  CAS  PubMed  Google Scholar 

  8. Thyagarajn D, Sunderamoorthy D, Haridas S, Beck S, Praven P, Johansen A (2009) MRSA colonisation in patients admitted with hip fracture: implications for prevention of surgical site infection. Acta Orthop Belg 75:252–257

    Google Scholar 

  9. Davis KA, Stewart JJ, Crouch HK, Florez CE, Hospenthal DR (2004) Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effects on subsequent MRSA infection. Clin Infect Dis 39:776–782

    Article  PubMed  Google Scholar 

  10. Hill C, Flamant R, Mazas F, Evard J (1981) Prophylactic cefazolin versus placebo in total hip replacement. Report of a multicentre double-blind randomised trial. Lancet 1:795–796

    Article  CAS  PubMed  Google Scholar 

  11. van Kasteren ME, Mannien J, Ott A, Kulberg BJ, de Boer AS, Gyssens IC (2007) Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Clin Infect Dis 44:921–927

    Article  PubMed  Google Scholar 

  12. Pollard JP, Hughes SP, Scott JE, Evans MJ, Benson MK (1979) Antibiotic prophylaxis in total hip replacement. Br Med J 1:707–709

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Southwell-Keely JP, Russo RR, March L, Cumming R, Cameron I, Brnabic AJ (2004) Antibiotic prophylaxis in hip fracture surgery: a metaanalysis. Clin Orthop Relat Res 419:179–184

    Article  PubMed  Google Scholar 

  14. Boyd RJ, Burke JF, Colton T (1973) A double-blind clinical trial of prophylactic antibiotics in hip fractures. J Bone Joint Surg Am 55:1251–1256

    CAS  PubMed  Google Scholar 

  15. Soriano A, Popescu D, Garcia S, Bori G, Martinez JA, Balasso V, Marco F, Almela M, Mensa J (2006) Usefulness of teicoplanin for preventing methicillin-resistant Staphylococcus aureus infections in orthopaedic surgery. Eur J Clin Microbiol Infect Dis 24:35–38

    Article  Google Scholar 

  16. Cox RA, Bowie PE (1999) Methicillin-resistant Staphylococcus aureus colonization: a prevalence study in Northamptonshire. J Hosp Infect 43:115–122

    Article  CAS  PubMed  Google Scholar 

  17. Barr B, Wilcox MH, Brady A, Parnell P, Darby B, Tompkins D (2007) Prevalence of methicillin-resistant Staphylococcus aureus colonization among older residents of care homes in the United Kingdom. Infect Control Hosp Epidemiol 28:853–859

    Article  PubMed  Google Scholar 

  18. Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R (2005) Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 87:844–850

    Article  CAS  PubMed  Google Scholar 

  19. Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE (2006) Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother 57:589–608

    Article  CAS  PubMed  Google Scholar 

  20. Darley ES, MacGowan AP (2004) Antibiotic treatment of gram-positive bone and joint infections. J Antimicrob Chemother 53:928–935

    Article  CAS  PubMed  Google Scholar 

  21. Joint Formulary Committee (2008) British national formulary, 55th edn. BMJ Group and Pharmaceutical Press, London

    Google Scholar 

  22. Periti P, Mini E, Mosconi G (1998) Antimicrobial prophylaxis in orthopaedic surgery: the role of teicoplanin. J Antimicrob Chemother 41:329–340

    Article  CAS  PubMed  Google Scholar 

  23. Suter F, Avai A, Fusco U, Gerundini M, Capriolo S, Maggiolo F (1994) Teicoplanin versus cefamandole in the prevention of infection in total hip replacement. Eur J Clin Microbiol Infect Dis 13:793–796

    Article  CAS  PubMed  Google Scholar 

  24. Vardakas KZ, Soteriades ES, Chrysanthopoulou SA, Papagelopoulos PJ, Falagas ME (2005) Perioperative anti-infective prophylaxis with teicoplanin compared to cephalosporins in orthopaedic and vascular surgery involving prosthetic material. Clin Microbiol Infect 11:775–777

    Article  CAS  PubMed  Google Scholar 

  25. Periti P, Stringa G, Mini E (1999) Comparative multicenter trial of teicoplanin versus cefazolin for antimicrobial prophylaxis in prosthetic joint implant surgery. Italian study group for antimicrobial prophylaxis in orthopaedic surgery. Eur J Clin Microbiol Infect Dis 18:113–119

    Article  CAS  PubMed  Google Scholar 

  26. Wall R, Klenerman L, McCullough C, Fyfe I (1988) A comparison of teicoplanin and cefuroxime as prophylaxis for orthopaedic implant surgery: a preliminary report. J Antimicrob Chemother 21:141–146

    Article  PubMed  Google Scholar 

  27. Edwards C, Counsell A, Boulton C, Moran CG (2008) Early infection after hip fracture surgery: risk factors, costs and outcome. J Bone Joint Surg Br 90:770–777

    Article  CAS  PubMed  Google Scholar 

  28. Murthy A, De Angelis G, Pittet D, Schrenzel J, Uckay I, Harbarth S (2010) Cost-effectiveness of universal MRSA screening on admission to surgery. Clin Microbiol Infect 16:1747–1753

    Article  CAS  PubMed  Google Scholar 

  29. Safdar N, Narans L, Gordon B, Maki DG (2003) Comparison of culture screening methods for detection of nasal carriage of methicillin-resistant Staphylococcus aureus: prospective study comparing 32 methods. J Clin Microbiol 41:3163–3166

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Giannoudis PV, Parker J, Wilcox MH (2005) Methicillin-resistant Staphylococcus aureus in trauma and orthopaedic practice. J Bone Joint Surg Br 87:749–754

    Article  CAS  PubMed  Google Scholar 

  31. Ritchie K, Bradbury I, Craig J, Eastgate J, Foster L, Kohli H et al. (2007) The clinical and cost-effectiveness of screening for MRSA. NHS Quality Improvement Scotland, HTA Report 9

  32. Aucken HM, Ganner M, Murchan S, Cookson BD, Johnson AP (2002) A new UK stain of epidemic methicillin-resistant Staphylococcus aureus (EMRSA-17) resistant to multiple antibiotics. J Antimicrob Chemother 50:171–175

    Article  CAS  PubMed  Google Scholar 

  33. De Lucas-Villarrubia JC, Lopez-Franco M, Granzio JJ, De Lucas-Garcia JC, Gomez-Barrena E (2004) Strategy to control methicillin-resistant Staphylococcus aureus post-operative infection in orthopaedic surgery. Int Orthop 28:16–20

    Article  PubMed Central  PubMed  Google Scholar 

  34. Murphy E, Spencer SJ, Young D, Jones B, Blyth MJG (2011) MRSA colonisation and subsequent risk of infection despite effective eradication in orthopaedic elective surgery. J Bone Joint Surg Br 93:548–551

    Article  CAS  PubMed  Google Scholar 

  35. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D (1984) Infection and sepsis after operations for total hip or knee-joint replacement: influence of ultraclean air, prophylactic antibiotics and other factors. J Hyg (Lond) 93:505–529

    Article  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kings Mill Hospital, Mansfield Road, Sutton-In-Ashfield, Nottinghamshire, NG17 4JL, UK

    David J. Bryson

  2. Department of Orthopaedics, William Harvey Hospital, Ashford, UK

    Abhinav Gulihar

  3. Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK

    Randeep S. Aujla & Grahame J. S. Taylor

Authors
  1. David J. Bryson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abhinav Gulihar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Randeep S. Aujla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Grahame J. S. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David J. Bryson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bryson, D.J., Gulihar, A., Aujla, R.S. et al. The hip fracture best practice tariff: early surgery and the implications for MRSA screening and antibiotic prophylaxis. Eur J Orthop Surg Traumatol 25, 123–127 (2015). https://doi.org/10.1007/s00590-014-1448-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-014-1448-6

Keywords

Search

Navigation