Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital (original) (raw)
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PLoS ONE, 2013
Introduction: The English Department of Health introduced universal MRSA screening of admissions to English hospitals in 2010. It commissioned a national audit to review implementation, impact on patient management, admission prevalence and extra yield of MRSA identified compared to "high-risk" specialty or "checklist-activated" screening (CLAS) of patients with MRSA risk factors. Methods: National audit May 2011. Questionnaires to infection control teams in all English NHS acute trusts, requesting number patients admitted and screened, new or previously known MRSA; MRSA point prevalence; screening and isolation policies; individual risk factors and patient management for all new MRSA patients and random sample of negatives. Results: 144/167 (86.2%) trusts responded. Individual patient data for 760 new MRSA patients and 951 negatives. 61% of emergency admissions (median 67.3%), 81% (median 59.4%) electives and 47% (median 41.4%) day-cases were screened. MRSA admission prevalence: 1% (median 0.9%) emergencies, 0.6% (median 0.4%) electives, 0.4% (median 0%) day-cases. Approximately 50% all MRSA identified was new. Inpatient MRSA point prevalence: 3.3% (median 2.9%). 104 (77%) trusts pre-emptively isolated patients with previous MRSA, 63 (35%) pre-emptively isolated admissions to "high-risk" specialties; 7 (5%) used PCR routinely. Mean time to MRSA positive result: 2.87 days (±1.33); 37% (219/596) newly identified MRSA patients discharged before result available; 55% remainder (205/376) isolated post-result. In an average trust, CLAS would reduce screening by 50%, identifying 81% of all MRSA. "High risk" specialty screening would reduce screening by 89%, identifying 9% of MRSA. Conclusions: Implementation of universal screening was poor. Admission prevalence (new cases) was low. CLAS reduced screening effort for minor decreases in identification, but implementation may prove difficult. Cost effectiveness of this and other policies, awaits evaluation by transmission dynamic economic modelling, using data from this audit. Until then trusts should seek to improve implementation of current policy and use of isolation facilities.
Screening for methicillin-resistant Staphylococcus aureus: A comparative effectiveness review
American Journal of Infection Control, 2014
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of health caree associated infections. Although the evidence in support of MRSA screening has been promising, a number of questions remain about the effectiveness of active surveillance. Methods: We searched the literature for studies that examined MRSA acquisition, MRSA infection, morbidity, mortality, harms of screening, and resource utilization when screening for MRSA carriage was compared with no screening or with targeted screening. Because of heterogeneity of the data and weaknesses in study design, meta-analysis was not performed. Strength of evidence (SOE) was determined using the system developed by the Grading of Recommendations Assessment, Development and Evaluation Working Group. Results: One randomized controlled trial and 47 quasi-experimental studies met our inclusion criteria. We focused on the 14 studies that addressed health careeassociated outcomes and that attempted to control for confounding and/or secular trends, because those studies had the potential to support causal inferences. With universal screening for MRSA carriage compared with no screening, 2 large quasiexperimental studies found reductions in health careeassociated MRSA infection. The SOE for this finding is low. For each of the other screening strategies evaluated, this review found insufficient evidence to determine the comparative effectiveness of screening. Conclusions: Although there is low SOE that universal screening of hospital patients decreases MRSA infection, there is insufficient evidence to determine the consequences of universal screening or the effectiveness of other screening strategies.
Usefulness of Weekly Methicillin‐Resistant Staphylococcus aureus Screening
Infection Control and Hospital Epidemiology, 2009
We evaluated the usefulness of adding weekly methicillin-resistant Staphylococcus aureus (MRSA) screening to our established admission screening and clinical sampling in 4 acute care units of a university hospital. Our results suggest that weekly MRSA screening allows the detection of 56.1% of all cases of hospital-acquired MRSA carriage. These cases would have remained undetected had admission screening and clinical sampling been the only types of surveillance in place.
Background: Methicillin Resistant Staphylococcus aureus (MRSA) is a common source of nosocomial infection, which is spreading through the community and hospitals across the countries. The performance of screening program really needs major effort related to laboratory capacity and ethical consideration, among other costly components. Significant literature research was conducted to review the cost, effectiveness and practicality of diffe rent methods of preadmission MRSA screening in the hospital setting. A systematic literature review was conducted with search strategy using the PubMed Medline, Scopus and the Science Direct databases. The relevant data was abstracted from all studies based on various countries which in line with the finalized eligibility criteria. Results: PCR method was reported to have high sensitivity with low turnaround time as compared to culture method. A review of selected studies found the increasing annual costs of screening from standard culture, chromogenic agar to rapid PCR. In the meantime, other studies reported the total costs for labor and materials was lower for rapid PCR screening compared to culture methods. The culturing method offers a high level of variability due to time consumption and additional costs. Whereas PCR was reported as advantageous in term of saving time to identify MRSA positive patients, which involved isolation,
Evidence for cost reduction based on pre-admission MRSA screening in general surgery
International Journal of Hygiene and Environmental Health, 2008
Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for MRSA infection causing increased costs in patient's care and treatment. To evaluate cost efficiency, pre-admission MRSA screening and subsequent MRSA decolonization of patients admitted to the Department of General Surgery at the University Hospital of Mu¨nster were determined. In 2004, 2054 (89.3%) out of the total of 2299 hospital-admitted patients were screened for MRSA (1769 elective and 530 direct admissions); 1536 patients underwent pre-admission MRSA screening (86.8% of the 1769 elective admissions), of whom seven patients (0.5%) were MRSA-positive and five of these were successfully decolonized before admission. In case of direct admissions, i.e., emergency cases or transferral from other hospitals, 2.4% and 8.6% were MRSA-positive, respectively. There were 25 patients MRSA positive during their hospital stay, two of these were nosocomially acquired, which represent 0.1 nosocomial MRSA cases in 1000 in-patients. The average MRSA carrier was (65715 years) older than the other patients (55717 years), had a significantly higher rate of pulmonary disease, coronary heart disease and certain infections; and had a longer hospital stay (27 versus 10 days, po0.05). The total costs of the MRSA screening were approximately 20,000h. Since the estimated costs for handling MRSA treatment and isolation during a hospital stay are 6000-10,000h for each affected patient, we estimated that approximately 20,000h could be saved by detecting and successfully decolonizing a total of five patients through pre-admission screening. In this calculation, additional costs due to the increased morbidity and mortality of MRSA carriers and the possible spread of MRSA through unrecognized colonization were not included. In conclusion, pre-admission screening for MRSA is an effective method to reduce the hospital burden of MRSA-colonized patients and the savings due to consistent decolonization before elective admission outweigh the costs of screening.