National guidelines recommend MRSA screening of all patients before elective orthopaedic implant procedures (EOIP) as a measure to reduce risk of MRSA surgical site infection (SSI). With low prevalence of MRSA in UK currently, this universal approach of screening all EOIP patients may be unnecessary.


To determine MRSA colonisation rate of EOIP patients pre surgery and number of MRSA-positive patients developing surgical site infection (SSI) within 30 days.


North Bristol NHS Trust is the largest Orthopaedic unit in Southwest England. It performs over 6000 elective Orthopaedic operations annually, including 2000 hip and knee joint replacements. All major elective cases are reviewed in a pre-operative assessment clinic where MRSA screening, amongst other tests, is performed.

The pathology IT system was interrogated to identify data on patients screened for MRSA in the orthopaedic pre-assessment clinic from 1st January to 31st March 2019. Routinely collected SSI data was reviewed for details of any SSI in these patients.


439 patients were screened in the pre-operative clinic. 4/439 patients (0.9%) had positive screens. Applying national MRSA screening criteria, 2/4 patients had recognised risk factors for MRSA colonisation (including one patient previously MRSA colonised), and 2/4 did not. All 4 patients were decolonised pre-surgery and none developed SSI. No patient developed MRSA SSI.


Approximately 1%, of patients attending for EOIP are colonised with MRSA in this Trust. No patient developed MRSA SSI in the 3month period. There may be potential to rationalise the approach to MRSA screening in EOIP patients.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.

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