A bundle that includes active surveillance, contact precaution for carriers, and cefazolin-based antimicrobial prophylaxis prevents methicillin-resistant Staphylococcus aureus infections in clean orthopedic surgery

Hideki Kawamura, Kazuaki Matsumoto, Akari Shigemi, Michiyo Orita, Aya Nakagawa, Satoko Nozima, Hiroyuki Tominaga, Takao Setoguchi, Setsuro Komiya, Koichi Tokuda, Junichiro Nishi

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10 Citations (Scopus)


Background Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of orthopedic surgical site infections (SSIs). The aim of this study was to evaluate the effect of a bundle approach in the prevention of orthopedic MRSA SSIs. Material and Methods MRSA active surveillance and decolonization were performed preoperatively at our institution from July 2004 until 2007. In January 2008, a bundle approach comprising contact precautions for MRSA-positive patients and cefazolin-based antimicrobial prophylaxis (AMP) stewardship was implemented. Data on the prevalence of MRSA SSIs, antimicrobial use density, duration of AMP, and the use of an alcohol antiseptic agent (L/1,000 patient-days) were evaluated during 2 periods: July 2004-December 2007 (period A) and January 2008-December 2012 (period B). Results and Discussion The MRSA SSI rate during period B (0.97%; 19 out of 1,966) was significantly lower than that during period A (2.17%; 29 out of 1,333; P =.003). The infection rate correlated negatively with both the cefazolin antimicrobial use density (r = -0.76; P =.0002) and the use of an alcohol antiseptic agent (r = -0.68; P =.002). Conclusions An infection-prevention bundle consisting of contact precautions for carriers and AMP stewardship in addition to active surveillance was associated with a significant decrease in the incidence of orthopedic MRSA SSIs.

Original languageEnglish
Pages (from-to)210-214
Number of pages5
JournalAmerican Journal of Infection Control
Issue number2
Publication statusPublished - 2016 Feb 1
Externally publishedYes



  • MRSA
  • Nasal screening
  • Orthopedic surgical site infection
  • Transmission

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • Epidemiology
  • Health Policy

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