Universal screening for meticillin-resistant Staphylococcus aureus: interim results from the NHS Scotland pathfinder project☆
Introduction
Meticillin-resistant Staphylococcus aureus (MRSA) infections are associated with greater risk of treatment failure, increased patient mortality and higher costs than infections with meticillin-susceptible S. aureus.1, 2 Within Europe, countries with low endemicity are observing an increase in the proportion of S. aureus cases due to MRSA; Scotland and the rest of the UK continue to have relatively high rates of MRSA, in common with Mediterranean countries, Romania and Ireland.3 MRSA is a particular challenge in hospitals as patients with wounds, invasive devices and weakened immune systems are at greater risk of infection than the general public.4
Uncertainty remains over the effectiveness of any single control measure compared with another, as they do not act independently and are often implemented concurrently. The Society for Healthcare Epidemiology of America guidelines have noted that multiple studies implementing surveillance, screening and contact precautions have resulted in a significant reduction in the rates of both MRSA colonisation and infection.5, 6 Screening identifies patients who are either colonised or infected, which allows targeted intervention to reduce the risk of endogenous infection and transmission to others.
Universal screening of all patients for MRSA continues to be controversial.7, 8 The most recent UK professional guidance on MRSA promotes targeted screening, but this has not been implemented in a consistent manner.9 Current MRSA screening practice within Scotland is locally determined, and is generally targeted on the basis of the perceived likelihood of MRSA carriage and risk of infection.
Policy proposals for universal MRSA screening of hospital patients have recently been developed in UK countries.10, 11, 12, 13, 14 This process in Scotland followed the publication of the National Health Service (NHS) Quality Improvement Scotland Health Technology Assessment (HTA) on the clinical- and cost-effectiveness of MRSA screening.15 An MRSA screening pilot study in Scotland was developed from the HTA recommendations, using the UK National Screening Committee screening criteria as a framework. These interim results present the findings from the first five months of data collection.
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Methods
This was a prospective cohort study in six hospitals in three regions (NHS Ayrshire and Arran, NHS Grampian and NHS Western Isles Health Board areas) in Scotland.
Participating hospitals followed the strategy recommended by the HTA which, of the six possible strategies investigated, was judged the most cost-effective and clinically effective approach.15 This strategy specified: screening all overnight admissions in acute specialties (excluding obstetrics, psychiatry and paediatrics); isolating
Results
The demographics of patients from the six hospitals (N = 29 690) inclusive of 15 081 admissions from Grampian Health Board, 13 700 from Ayrshire and Arran and 909 from Western Isles are presented in Table I.
The overall prevalence of MRSA colonisation during the study period was 7.47%, representing the burden of patients requiring intervention at any given point in time. Table II shows that 26 160 patients (88.1% of total hospital admissions) were screened either at pre-admission clinics or on
Discussion
This is the first UK pilot study for a national MRSA screening programme. The total prevalence of MRSA colonisation at time of admission was found to be 7.5%. The percentage of patients identified as colonised by screening was 3.8% but, in addition, 5.9% of admissions (screened or not) were known previous MRSA positives. Prevalence of MRSA colonisation is defined in different ways in the published literature, which makes comparisons difficult but highlights the need for consistency.1, 8, 16
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Cited by (37)
Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Colonization Among Patients Admitted to Obstetrical Units: A Nested Case-Control Study
2018, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Identifying MRSA colonization and infection among obstetrical patients is a priority for hospitals and obstetrical units because it can optimize (or direct) empirical therapy for infections where S. aureus may be a pathogen, thereby starting effective treatment earlier and potentially improving outcomes. However, the value of universal MRSA screening remains controversial,17–22 and many studies have demonstrated that risk factor–based screening may be sufficiently effective to reduce MRSA transmission.23 Studies at our facility, The Ottawa Hospital in Ottawa, concluded that universal MRSA screening was neither clinically effective nor cost effective in the admitted population.24,25
Predictors of methicillin-resistant Staphylococcus aureus colonization at hospital admission
2013, American Journal of Infection ControlAn effective active surveillance method for controlling nosocomial MRSA transmission in a Japanese hospital
2013, Journal of Infection and ChemotherapyImpact of nursing home residence on hospital epidemiology of meticillin-resistant Staphylococcus aureus: A perspective from Asia
2013, Journal of Hospital InfectionCitation Excerpt :Residence in nursing homes is a known risk factor for meticillin-resistant Staphylococcus aureus (MRSA) infection and colonization in the USA and Europe.1–3
Risk factors for previously unknown meticillin-resistant Staphylococcus aureus carriage on admission to 13 surgical wards in Europe
2013, Journal of Hospital InfectionCitation Excerpt :However, there were no risk factors common to more than two centres. These differences may explain the wide variation in MRSA prevalence on admission in different countries and even among wards of the same facility.18 Based on these data, local prediction rules may be more accurate than generic national or international scores in identifying unknown MRSA carriers.
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The full report was published on the Health Protection Scotland website on 8 April 2008: www.hps.scot.nhs.uk.ISBN 978-1-873772-27-0.