title: Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study.
abstract: Identification of patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) and subsequent isolation and decolonization is pivotal to the control of cross infection in hospitals. The aim of this study was to establish if early identification of colonized patients using rapid methods alone reduces transmission. A prospective, cluster, two-period cross-over design was used. Seven surgical wards at a large hospital were allocated to two groups, and for the first 8 months four wards used rapid MRSA screening and three wards used a standard culture method. The groups were reversed for the second 8 months. Regardless of the method of detection, all patients were screened for nasal carriage on admission and then every 4 days. MRSA control measures remained constant. Results were analysed using a log linear Poisson regression model. A total of 12 682/13 952 patient ward episodes (PWE) were included in the study. Admission screening identified 453 (3.6%) MRSA-positive patient ward episodes, with a further 268 (2.2%) acquiring MRSA. After adjusting for other variables, rapid screening was shown to statistically reduce MRSA acquisition, with patients being 1.49 times (p 0.007) more likely to acquire MRSA in wards where they were screened using the culture method. Screening of surgical patients using rapid testing resulted in a statistically significant reduction in MRSA acquisition. This result was achieved in a routine surgical service with high bed occupancy and low availability of isolation rooms, making it applicable to the majority of health-care systems worldwide.
authors.affiliation: West Midlands Public Health Laboratory, Heart of England NHS Foundation Trust, Birmingham, UK. Katie.Hardy@heartofengland.nhs.uk
authors.forename: Katherine
authors.initials: K
authors.lastname: Hardy
authors.forename: Charlotte
authors.initials: C
authors.lastname: Price
authors.forename: Ala
authors.initials: A
authors.lastname: Szczepura
authors.forename: Savita
authors.initials: S
authors.lastname: Gossain
authors.forename: Ruth
authors.initials: R
authors.lastname: Davies
authors.forename: Nigel
authors.initials: N
authors.lastname: Stallard
authors.forename: Sahida
authors.initials: S
authors.lastname: Shabir
authors.forename: Claire
authors.initials: C
authors.lastname: McMurray
authors.forename: Andrew
authors.initials: A
authors.lastname: Bradbury
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hawkey
mesh_terms: D003428:Cross Infection / Q000175:diagnosis* / Q000517:prevention & control; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D013503:Surgery Department, Hospital