title: A study of the efficacy and cost-effectiveness of MRSA screening and monitoring on surgical wards using a new, rapid molecular test (EMMS).
abstract: BACKGROUND
  MRSA is a significant contributor to prolonged hospital stay, poor clinical outcome and increased healthcare costs amongst surgical patients. A PCR test has been developed for rapid detection of MRSA in nasal swabs. The aims of this study are (1) to estimate the effectiveness of screening using this rapid PCR tests vs culture in reducing MRSA cross-infection rates; (2) to compare the cost of each testing strategy, including subsequent health care costs; and (3) to model different policies for the early identification and control of MRSA infection in surgical patients.
  
  
  METHODS
  The study is a prospective two-period cross-over study set in 7 surgical wards covering different surgical specialities. A total of 10,000 patients > 18 years will be tested over 16 months. The only difference between the two study periods is the method used for the detection of MRSA in each ward (rapid v conventional culture), with all other infection control practices remaining consistent between the arms. The study has been designed to complement routine practice in the NHS. Outcomes are MRSA cross-infection rates (primary outcome) and need for antibiotic therapy and MRSA-related morbidity. Parallel economic and modelling studies are being conducted to aid in the interpretation of the results and to evaluate the cost-effectiveness of the rapid PCR screening strategy.
  
  
  CONCLUSIONS
  This paper highlights the design, methods and operational aspects of a study evaluating rapid MRSA screening in the surgical ward setting.
authors.affiliation: West Midlands Public Health Laboratory, Health Protection Agency, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS, UK. Katie.Hardy@heartofengland.nhs.uk
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Hardy
authors.forename: Ala
authors.initials: A
authors.lastname: Szczepura
authors.forename: Ruth
authors.initials: R
authors.lastname: Davies
authors.forename: Andrew
authors.initials: A
authors.lastname: Bradbury
authors.forename: Nigel
authors.initials: N
authors.lastname: Stallard
authors.forename: Savita
authors.initials: S
authors.lastname: Gossain
authors.forename: Paul
authors.initials: P
authors.lastname: Walley
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hawkey
mesh_terms: D000328:Adult; D000368:Aged; D019411:Clinical Laboratory Techniques / Q000191:economics; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006757:Hospital Units / Q000191:economics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D016106:Methicillin Resistance / Q000235:genetics; D008826:Microbial Sensitivity Tests / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology*; D016133:Polymerase Chain Reaction / Q000191:economics*; D011183:Postoperative Complications / Q000382:microbiology* / Q000517:prevention & control; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D013997:Time Factors