Should we screen low risk patients for meticillin resistant Staphylococcus aureus?

BMJ 2009; 339 doi: (Published 08 October 2009) Cite this as: BMJ 2009;339:b4035
  1. Michael Millar, consultant microbiologist
  1. 1Department of Infection, Barts and The London NHS Trust, London E1 2ES
  1. michael.millar{at}
  • Accepted 23 September 2009

Department of Health policy requiring all hospital patients to be screened for MRSA breaches ethical guidelines, argues Michael Millar

Since April 2009, all patients electively admitted to English hospitals must be screened for meticillin resistant Staphylococcus aureus (MRSA).1 The requirement will be extended to emergency admissions from next year. Although the policy is presented as a population screening programme, most people who are screened will gain little benefit and may be harmed. The justification for universal screening is therefore unclear.

Control policy

The Department of Health has taken increasingly stringent measures since 2001 to reduce the burden of infection associated with MRSA. The measures seem to have been successful, with the numbers of MRSA bloodstream infections falling by more than half from 2003 to 2008. However, the overall numbers of healthcare associated infections reported to the English Health Protection Agency rose substantially, raising questions about the focus on MRSA.2 3

Before April 2009 most NHS trusts screened patients for MRSA when they were considered to be at high risk of MRSA colonisation or infection. The mandatory MRSA screening policy extends the range of individuals screened to include people at low risk of MRSA colonisation or infection, such as patients without serious comorbidity admitted for hernia repair or arthroscopy. The policy runs contrary to current UK guidelines for the control of MRSA, which emphasise selective screening,4 and to US guidelines, which do not support legislation to mandate MRSA screening.5

In the UK, hospital admission is the main risk factor for acquiring MRSA, and invasive medical procedures (particularly placement of a central venous catheter) are the biggest risk factor for MRSA bloodstream infections. About half of people admitted to hospital will be in the low risk category.4 5 The evidence supporting screening even in high risk groups is largely …

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