MRSA screening in the vascular day-case population.
BACKGROUND
The UK Government has prioritised methicillin-resistant Staphylococcus aureus (MRSA) screening and new operational guidance has instructed that all day-case surgical patients should be screened from April 2009. We sought to identify the number of MRSA-positive patients in the vascular day-case population over a 1-year period and to profile this cohort in terms of risk-factors for MRSA. We also sought to identify whether the new guidance from the Department of Health (DH) had resulted in increased screening rates.


METHODS
Electronic records and laboratory culture results were prospectively consulted to identify whether patients had been screened and if MRSA had been isolated. Consideration was given to whether any patients had a delayed discharge or subsequent admission with an MRSA-related complication.


RESULTS
Six patients (2.1%) screened MRSA-positive (DH estimate 7%); five were previously known to be MRSA-positive, therefore only 0.36% patients were newly-identified as MRSA-positive. The proportion of patients screened increased from 35% to 72.5% after April 2009, in accordance with DH guidance. Successful decolonisation was proved in two patients (33.3%).


CONCLUSIONS
There is dispute with several of the key assumptions behind the DH's impact assessment justifying an expanded MRSA-screening policy. It is not cost-effective to screen all vascular day-case admissions. We recommend selective screening for patients previously identified as MRSA-positive, or considered high risk.
Ahmad
Y
Y
Department of Vascular Surgery, Selly Oak Hospital, University Hospitals Birmingham NHS Foundation Trust, UK. yousif.ahmad@uhb.nhs.uk
Khandelwal
S
S
Nicolson
A M
AM
Simms
M H
MH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000191:economics; D006113:United Kingdom; D014656:Vascular Surgical Procedures