Impact of rapid molecular screening for meticillin-resistant Staphylococcus aureus in surgical wards.
BACKGROUND
This study aimed to establish the feasibility and cost-effectiveness of rapid molecular screening for hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) in surgical patients within a teaching hospital.


METHODS
In 2006, nasal swabs were obtained before surgery from all patients undergoing elective and emergency procedures, and screened for MRSA using a rapid molecular technique. MRSA-positive patients were started on suppression therapy of mupirocin nasal ointment (2 per cent) and undiluted chlorhexidine gluconate bodywash.


RESULTS
A total of 18,810 samples were processed, of which 850 (4.5 per cent) were MRSA positive. In comparison to the annual mean for the preceding 6 years, MRSA bacteraemia fell by 38.5 per cent (P < 0.001), and MRSA wound isolates fell by 12.7 per cent (P = 0.031). The reduction in MRSA bacteraemia and wound infection was equivalent to a saving of 3.78 beds per year (276,220 pounds sterling), compared with the annual mean for the preceding 6 years. The cost of screening was 302,500 pounds sterling, making a net loss of 26,280 pounds sterling. Compared with 2005, however, there was a net saving of 545,486 pounds sterling.


CONCLUSIONS
Rapid MRSA screening of all surgical admissions resulted in a significant reduction in staphylococcal bacteraemia during the screening period, although a causal link cannot be established.
Department of Surgery, Windeyer Institute of Medical Sciences, University College London Hospitals Foundation Trust, London, UK. m.keshtgar@ucl.ac.uk
M R S
MR
Keshtgar
A
A
Khalili
P G
PG
Coen
C
C
Carder
B
B
Macrae
A
A
Jeanes
P
P
Folan
D
D
Baker
M
M
Wren
A P R
AP
Wilson
D016470:Bacteremia / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data; D006801:Humans; D016106:Methicillin Resistance; D009666:Nose / Q000382:microbiology; D010349:Patient Compliance; D016133:Polymerase Chain Reaction / Q000379:methods; D013048:Specimen Handling; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013503:Surgery Department, Hospital; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*