title: Universal screening for meticillin-resistant Staphylococcus aureus in acute care: risk factors and outcome from a multicentre study.
abstract: BACKGROUND
  A Health Technology Assessment (HTA) model on effectiveness of meticillin-resistant Staphylococcus aureus (MRSA) screening in Scotland suggested that universal screening using chromogenic agar was the preferred option in terms of effectiveness and cost.
  
  
  OBJECTIVE
  To test the model's validity through a one-year pilot-study.
  
  
  METHODS
  A large one-year prospective cohort study of MRSA screening was carried out in six acute hospitals in NHS Scotland, incorporating 81,438 admissions. Outcomes (MRSA colonization and infection rates) were subjected to multivariable analyses, and trends before and after implementation of screening were compared.
  
  
  RESULTS
  The initial colonization prevalence of 5.5% decreased to 3.5% by month 12 of the study (P < 0.0001). Colonization was associated with the number of admissions per patient, specialty of admission, age, and source of admission (home, other hospital or care home). Around 2% of all admissions with no prior history of MRSA infection or colonization tested positive. Those who were screen positive on admission and not previously known positive were 12 times more likely than those who screened negative to develop infection, increasing to 18 times if they were both screen positive and previously known positive. MRSA infections (7.5 per 1000 inpatient-days overall) also reduced significantly over the study year (P = 0.0209).
  
  
  CONCLUSIONS
  The risk factors identified for colonization and infection indicate that a universal clinical risk assessment may have a role in MRSA screening.
authors: Health Protection Scotland, Glasgow, UK. jacquelinereilly@nhs.net
authors: J S
authors: JS
authors: Reilly
authors: S
authors: S
authors: Stewart
authors: P
authors: P
authors: Christie
authors: G M
authors: GM
authors: Allardice
authors: T
authors: T
authors: Stari
authors: A
authors: A
authors: Matheson
authors: R
authors: R
authors: Masterton
authors: I M
authors: IM
authors: Gould
authors: C
authors: C
authors: Williams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001431:Bacteriological Techniques / Q000379:methods*; D002353:Carrier State / Q000175:diagnosis* / Q000382:microbiology; D015331:Cohort Studies; D003470:Culture Media / Q000737:chemistry; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012606:Scotland; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology
chemical_list: D003470:Culture Media