Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial.
OBJECTIVE
To determine whether introducing a rapid test for meticillin resistant Staphylococcus aureus (MRSA) screening leads to a reduction in MRSA acquisition on hospital general wards.


METHODS
Cluster randomised crossover trial.


METHODS
Medical, surgical, elderly care, and oncology wards of a London teaching hospital on two sites.


METHODS
MRSA acquisition rate (proportion of patients negative for MRSA who became MRSA positive).


METHODS
All patients admitted to the study wards who were MRSA negative on admission and screened for MRSA on discharge.


METHODS
Rapid polymerase chain reaction based screening test for MRSA compared with conventional culture.


RESULTS
Of 9608 patients admitted to study wards, 8374 met entry criteria and 6888 had full data (82.3%); 3335 in the control arm and 3553 in the rapid test arm. The overall MRSA carriage rate on admission was 6.7%. Rapid tests led to a reduction in median reporting time from admission, from 46 to 22 hours (P<0.001). Rapid testing also reduced the number of inappropriate pre-emptive isolation days between the control and intervention arms (399 v 277, P<0.001). This was not seen in other measurements of resource use. MRSA was acquired by 108 (3.2%) patients in the control arm and 99 (2.8%) in the intervention arm. When predefined confounding factors were taken into account the adjusted odds ratio was 0.91 (95% confidence interval 0.61 to 1.234). Rates of MRSA transmission, wound infection, and bacteraemia were not statistically different between the two arms.


CONCLUSIONS
A rapid test for MRSA led to the quick receipt of results and had an impact on bed usage. No evidence was found of a significant reduction in MRSA acquisition and on these data it is unlikely that the increased costs of rapid tests can be justified compared with alternative control measures against MRSA.


BACKGROUND
Clinical controlled trials ISRCTN75590122 [controlled-trials.com].
Jeyaratnam
Dakshika
D
Department of Infection, Guys and St Thomas' NHS Foundation Trust, London. dakshika.jeyaratnam@kcl.ac.uk
Whitty
Christopher J M
CJ
Phillips
Katie
K
Liu
Dongmei
D
Orezzi
Christina
C
Ajoku
Uchechukwu
U
French
Gary L
GL
D016000:Cluster Analysis; D003428:Cross Infection / Q000175:diagnosis*; D018592:Cross-Over Studies; D006801:Humans; D016106:Methicillin Resistance; D019095:Point-of-Care Systems; D016133:Polymerase Chain Reaction / Q000379:methods; D013203:Staphylococcal Infections / Q000175:diagnosis*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016896:Treatment Outcome; D014946:Wound Infection / Q000175:diagnosis