Safe and Sound?

It is no secret—MRSA kills. It is also no secret that MRSA is a huge ongoing obstacle facing all health-care professionals; orthpaedic surgeons are no exception. There are two forms of this infection, community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which is clinically distinct from (HA-MRSA) or hospital-acquired.

A report released by the Centers for Disease Control and Prevention in 2007 shows:
• 94,360 invasive MRSA infections occurred in the United States in 2005
• 18,650 people died from those infections
• 85 percent were health-care associated

The incidence of this serious infection is increasing and of great concern to doctors worldwide. “I believe this could be our first ‘plague’ of the 21st century,” said Richard Parker Evans, MD, chief of adult reconstructive surgery and associate professor of orthopaedics at the University of Arkansas for Medical Sciences, Little Rock. Surgery sites are particularly prone to developing MRSA infections, especially open fractures with large wounds.

More than 500,000 surgical-site infections occur every year. “The biggest issue,” Dr. Evans noted, “is that these bugs are becoming bulletproof, and we are running out of options to treat them. As orthopaedic surgeons, learning how to prevent them is going to be the key for us and for the safety of our patients in the long run.”

Several crucial topics surrounding MRSA and surgical-site infections will be presented in a media briefing entitled, “Safe and Sound: Controlling Infection on Every Front, MRSA and Beyond,” taking place Thursday, Mar. 6, 2008, at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) at the Moscone Convention Center, South Mezzanine, at 10 a.m., in Room 224.

Dr. Evans will moderate a panel discussing how MRSA has become a worldwide phenomenon. He will also talk about two additional infections, vancomycin-intermediate sensitive (VISA) and vancomycin-resistant Staphylococcus aureus (VRSA), which loom as future problems.

Terry Clyburn, MD, presents what current evidenced-based recommendations and trends are available for the prevention of musculoskeletal surgical infections. David Wong, MD, brings a worldwide perspective to the panel. Just back from the World Health Organization (WHO) meeting in Geneva, Switzerland, he will have an update on how the organization is tackling this problem.

Dr. James P. Stannard, MD, presents findings of a randomized study on how using negative pressure wound therapy (NPWT) and a medical device called the “VAC” can help guard against infection and wound breakdown following high-risk fracture surgery. Dr. Stannard is professor of surgery in the Department of Orthopaedic Surgery and chief of Orthopaedic Trauma at the University Alabama at Birmingham.

“We hit the wound with sub-atmospheric pressure or negative pressure,” Dr. Stannard said. “Much like if you were to put the nozzle of a vacuum cleaner against your leg, the VAC creates a suction, which helps pull off excess fluid and increase blood flow to the site.”