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Rapid Responses: Rapid Responses published:
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MRSA screening
- SIMON F HILL (20 March 2009)
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Meticillin resistant Staphylococcus aureus in the hospital
- Nazar R Dessouki, Cairo Egypt (21 March 2009)
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SIMON F HILL, Consultant Microbiologist Poole Hospital NHS Foundation Trust , Poole, Dorset BH21 3XA
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The discussion in the recent article by Kluytmans and Struelens(1) on MRSA in hospital concluded that the most important site to screen for MRSA carriage was the nose and that screening other non-clinical sites ( perineum,groin or axilla)was not useful. This is contrary to the practice in most UK hospitals where the perineum/groin is also screened based on the national guidelines published in 2006 (2).Screening the nose alone will detect around 80% of carriers,incuding the perineum increases this to 93% (3).Not only is the overall detection rate increased but detection of perineal carriers is important because this is correlated with more heavy dispersal of MRSA into the environment (4,5),perineal carriers also have heavy contamination of the groin and thigh (6,7).Persistant carriers also have more Staph aureus cultured from the perineal area than transient carriers (6,7). This is an important issue for trusts having to implement the Department of Health's requirement to screen all elective admissions by 1st April 2009 (8,9).The operational guidance is not specific in which sites should be screened apart from the nose and it is left to the microbiologist and Infection Prevention and Control Teams to decide if other sites should be included. The guidance should be more definite and either accept missing some heavy shedders of MRSA by screening the nose only,or include a perineal screen and accept that this will require extra resources in nursing time to obtain the screen and laboratory cost and time to process the addititional samples. 1.Kluytmans J,Struelens M.Meticillin resistant Staphylococcus aureus in the hospital.BMJ 2009;338:532-37. 2.Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA)in healthcare facilities by the joint BSAC/HIS/ICNA working party on MRSA.J Hosp Infection 2006;(Suppl 1)63. 3.Coello R,Jimenez J,Garcia M et al.Prospective study of infection,colonisation and carriage of methicillin-resistant Staphylococcus aureus affecting 900 patients.Eur J Clin Microbiol Infect Dis 1994;13:74-81. 4.Ayliffe GAF,Babb JR,Collins BJ.Dispersal and skin carriage of Staphylococcus aureus in healthy male and female subjects and pateints with skin disease.In:Hers JFPh,Winkler KC Eds.Airborne transmission and airborne infection.IV International Symposium on Aerobiology 1973;435-37. 5.Blowers R,Hill J,Howell A.Shedding of Staph aureus by human carriers.In:Hers JFPh,Winkler KC Eds.Airborne transmission and airborne infection.IV International Symposium on Aerobiology 1973;432-34. 6.Ridley M.perineal carriage of Staph aureus.BMJ 1959;1:270-73 7.Solberg CO.Astudy of carriers of Staph aureus.Acta ned Scan 1965;17(Suppl 436):1-96. 8.MRSA-Operational Guidance.Dept Health.July 2008.Gateway ref 10324. 9.MRSA Screening-Operational Guidance 2.Dept Health .Dec 2008.Gateway ref 11123. Competing interests: None declared |
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Nazar R Dessouki, Consultant Surgeon , Clinical lecturer Cairo University Medical School Hospital, Cairo Egypt
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Patients being admitted to the hospitals above will all be asked to allow a swab of their nasal cavity to be taken. Swabs will then be tested for MRSA according to normal standard laboratory procedures. Swabs can be taken either at pre-admission clinics for those having elective inpatient procedures, or on admission. Testing normally takes at least 2 days to obtain a result. Patients screened prior to admission who have a positive test will be requested to undergo decolonisation treatment which consists of using an antibiotic ointment in their nose and anti-bacterial body wash prior to their admission to hospital. Patients who have been admitted and are subsequently found to be colonised will be isolated or cohorted and will undergo decolonisation. Patients will be considered to remain colonised until they have had three consecutive negative screens. Data will be collected by dedicated data collection staff and this will include their patients dates of admission and discharge and the specialty to which they are admitted; the dates and results of MRSA screening tests; details of any isolation, cohorting or decolonisation procedures; and infections if they occur. Competing interests: None declared |
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