Meticillin resistant Staphylococcus aureus in the hospital
BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b364 (Published 12 February 2009) Cite this as: BMJ 2009;338:b364
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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
Competing interests: No competing interests
Meticillin resistant Staphylococcus aureus in the hospital
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
Competing interests: No competing interests