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Universal MRSA screening at admission does not improve hospital infection rates
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Recent data suggest universal MRSA admission screening in hospitals is no more effective than risk factor-based screening for reducing the rate of nosocomial MRSA infection.
“There is conflicting evidence regarding which admission screening approach is most clinically effective in reducing nosocomial MRSA transmission and infection,” the researchers wrote. “Despite improved detection, universal screening was not more effective in reducing nosocomial MRSA transmission in our hospital.”
Researchers examined data from patients admitted to the Ottawa Hospital tertiary care facility from Jan. 1, 2006 to Dec. 31, 2007, when admitted patients received risk factor-based MRSA screening, and Jan. 1, 2008 to Aug. 31, 2009, when universal screening was implemented. Screening swab specimens were obtained from the nares and rectums of patients, as well as from catheter exit sites and open skin lesions when applicable, and were tested using a commercial real-time PCR assay. Researchers primarily observed the incidence rate of nosocomial MRSA infections, but also collected data concerning MRSA detection through screening, demographic information and relevant clinical characteristics. In addition, regional MRSA rates, decolonization therapy frequency and nosocomial C. difficile incidence were observed and incorporated into the analytical model to remove potentially confounding factors.
There were 323 nosocomial MRSA cases during the preintervention period and 321 cases during the postintervention period, resulting in incidence rates of 41.8 per 100,000 patient-days and 47.5 per 100,000 patient-days. One percent of the 76,273 patients screened during the preintervention period were positive for MRSA, while 2.6% of the 61,782 patients screened during the postintervention period were positive. This translated to MRSA detection rates of 9.8 per 1,000 admissions and 26.2 per 1,000 admissions for the pre- and postintervention periods, respectively. Despite an observed reduction in regional MRSA rates, the researchers found no significant difference in nosocomial cases during the period of universal screening and, as a result, universal screening has been discontinued at Ottawa Hospital.
“To the best of our knowledge, this is the first study to compare the clinical effectiveness of a hospital-wide universal MRSA screening intervention in reducing the nosocomial transmission of MRSA compared with risk factor–based screening using robust data and analytical techniques to control for confounding and secular trends,” the researchers wrote. “These findings provide further evidence that hospital-wide universal MRSA admission screening is not clinically effective in reducing the nosocomial transmission of MRSA.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures
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