Eradication of methicillin resistant Staphylococcus aureus by "ring fencing" of elective orthopaedic beds.

PROBLEM: Deep infection after joint arthroplasty can be catastrophic, leading to further surgery, loss of the prosthesis, disability, and risk of mortality. Twenty nine new cases of methicillin resistant Staphylococcus aureus occurred in the first year after elective orthopaedic surgery was centralised to a district general hospital in Essex. DESIGN: Prospective trial to establish whether ring fencing of elective orthopaedic beds and introduction of simple infection control measures has an effect on the rates of postoperative infections and number of patients treated. PARTICIPANTS AND SETTING: All patients undergoing primary hip or knee replacement in a district general hospital in Essex, England, between July 1999 and July 2001. MAIN MEASURES FOR IMPROVEMENT: Number of patients having joint replacement; number of all postoperative infections in the participant group; number of cases of methicillin resistant Staphylococcus aureus. STRATEGIES FOR CHANGE: Ring fencing of the elective orthopaedic ward and introduction of simple infection control measures. EFFECTS OF CHANGE: The incidence of all postoperative infections decreased from 43/417 to 15/488 (P < 0.0001), with no new cases of methicillin resistant Staphylococcus aureus. LESSONS LEARNT: The introduction of a ring fenced elective orthopaedic ward and simple infection control measures allowed 17% more patients to be treated and significantly reduced the incidence of all postoperative infections.

Non-invasive diagnosis of Helicobacter pylori infection in adult dyspeptic patients by stool antigen detection: does the rapid immunochromatography test provide a reliable alternative to conventional ELISA kits?

Stool antigen-testing allows non-invasive detection of Helicobacter pylori that is indicative of active infection. Three commercial kits are currently marketed in the UK for stool antigen-testing. The aim of this study was to conduct a comparative evaluation of the performances of each of these tests, compared with culture and histological examination of gastric biopsies, for pre-treatment diagnosis of infection in an adult dyspeptic population in south-east England. Examination of 112 stool samples by the Premier Platinum HpSA ELISA (Meridian Diagnostics) and by the Amplified IDEIA HpStAR ELISA (DakoCytomation) kits demonstrated that the latter was more sensitive (81.3 versus 93.8%, respectively) and specific (91.7 versus 100.0%, respectively). Additionally, the IDEIA HpStAR was easier to interpret, with OD readings of positive and negative results being far from the recommended cut-off, whereas equivocal results that were generated by the HpSA kit were difficult to interpret. Additional testing of 87 of the 112 stools by the ImmunoCard STAT! HpSA kit (Meridian Diagnostics) demonstrated that this test was easier to perform than ELISA and was more sensitive than the HpSA kit but, compared with the IDEIA HpStAR kit, the ImmunoCard test was less sensitive (87.8 versus 95.9%, respectively) and specific (89.4 versus 100.0%, respectively). Furthermore, the ImmunoCard test generated weakly positive results, correlating with lower OD readings for both ELISA kits, that were difficult to interpret. The Amplified IDEIA HpStAR kit is therefore the most sensitive and specific of the three tests that are available for pre-treatment, non-invasive detection of H. pylori in stool samples in an English adult dyspeptic population.