title: MRSA screening in orthopaedic surgery: clinically valuable and cost effective? A prospective analysis of 8,867 patients.
abstract: This study aimed at assessing the prevalence of MRSA colonisation in Trauma and Orthopaedics. Risk factors, decolonisation, and subsequent infection rates were investigated. Cost-analysis of the MRSA screening program was performed. The validity and effectiveness of the MRSA screening program was reviewed. A prospective analysis was made of all orthopaedic admissions in East Lancashire Hospital Trust. A total number of 13,155 swabs were taken in 8,867 patients in 2010. This MRSA screening program was compared to the ideal screening criteria set out by Wilson and Junger (WHO 1968). The MRSA prevalence in Trauma and Orthopaedics in 2010 was 0.47%. The decolonisation rate was 55%. There was no correlation between MRSA colonisation and subsequent infection. The total cost of MRSA screening at ELHT was calculated as a minimum of 184,170 Pounds. This could extrapolate to a national expense of around 16 million pounds in England and Wales in Orthopaedics alone. The MRSA screening program did not meet 4 out of 9 screening criteria of Wilson and Junger. The vast majority of Trauma and Orthopaedic patients are not at risk of MRSA colonisation or infection and therefore should not be screened. MRSA infection is a risk in certain high risk groups which should be screened. The MRSA screening program is ineffective when assessed to WHO standards. The program should be considered to be surveillance of MRSA, not an effective screening program for pathological MRSA infection.
authors.affiliation: East Lancashire Hospitals NHS Trust, UK. bilalb1@hotmail.com
authors.forename: Bilal M
authors.initials: BM
authors.lastname: Barkatali
authors.forename: Nick
authors.initials: N
authors.lastname: Heywood
authors.forename: Ruth
authors.initials: R
authors.lastname: White
authors.forename: Robin W
authors.initials: RW
authors.lastname: Paton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology; D019637:Orthopedic Procedures; D015995:Prevalence; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000382:microbiology