Prevention of pin site infection using a novel antimicrobial-impregnated collar

Background and aims Pin site infection (PSI) is a common complication of external fixation which can cause significant morbidity. Additional treatment required as a result of PSI can be costly in terms of NHS time and resources, but also personal and financial losses for those undergoing additional treatment. A reduction in PSI would therefore reduce the complications and costs associated with infection. The aim of the study is to determine the feasibility of antimicrobial impregnated collars in preventing PSI in patients with external fixation. Methods Current pin site care practices were identified by using an electronic questionnaire. Assessment of bacteria present at clinically non-infected and infected pin sites was determined through evaluating swabs obtained from the out-patient setting. Bacterial isolates were tested for antimicrobial sensitivity and biofilm capacity. Pre-clinical testing of the antimicrobial collar used bacterial isolates identified from the PSI evaluation. Test strains included S aureus, S epidermidis, corynebacteria and E coli. Pre-clinical tests included SPTT, tK100, and an in-vitro pin site model. A single-centre randomised control feasibility study was conducted with participants allocated to standard care or antimicrobial collar. Primary endpoints included number of participants with PSI, number of infected pin sites and bacteria present at pin sites at 3 months. Main findings Pin site care remains varied across the UK despite the availability of the UK Consensus Guidelines (Timms et al 2011). Pin site care is also inconsistent internationally. The bacterial evaluation identified large number of CoNS (46.2%), corynebacteria (10.7%) and S aureus (4.1%) in clinically non infected pin sites, although the significant increase of S aureus to 17.9% in PSI (p