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UCLH research study shows rapid screening for MRSA can cut hospital infections by 40 percent

BD Diagnostics : 21 December, 2007  (New Product)
University College London Hospital NHS Foundation Trust (UCLH) has published a major research study that demonstrates rapid screening for meticillin-resistant Staphylococcus aureus (MRSA) could help reduce hospital infection rates by almost 40 per cent.
Led by researchers at UCLH, the study investigated whether using a two-hour rapid screening test to identify MRSA carriers could effect a significant reduction in infection rates. The researchers who conducted the trial of approximately 19,000 surgical patients at University College Hospital concluded that use of the rapid molecular test is cost-effective and reduces MRSA infection rates.

MRSA has a devastating impact on patients and their families,” said Peter Wilson, consultant microbiologist, UCLH, who led the research study. “To win the war on MRSA, hospitals need to consider effective new technologies, such as rapid tests which can help speed the selection of appropriate interventions. It is important to identify methods which can be demonstrated to be effective in reducing hospital infection rates. Our research shows rapid molecular screening to identify carriers prior to elective or emergency surgery is an important tool toward that goal.

The authors tested 18,810 surgery patients admitted to the hospital between January and December 2006 with the BD Diagnostics' BD GeneOhm MRSA Assay, a rapid, two-hour molecular test for the detection of MRSA from nasal specimens. The rapid test revealed that 4.5 per cent of screened patients were carrying MRSA when they were admitted to the hospital.

Patients who tested positive as carriers of MRSA were treated with a topical suppression in order to reduce the risk of infection and potential transmission to others. The overall rate of MRSA bloodstream infections fell by 38.6 per cent compared with 2005 rates. When compared with the mean of the preceding six years, the rate fell by 38.5 per cent.

The annual cost for the active screening programme at UCLH was 302,500. Cost savings were measured in terms of sending a patient home earlier as an infection was avoided. Using the 2005 MRSA infection rates, the cost savings in 2006 were 545,400, translating to a net savings of 242,900 for the year.

Based upon the success of the active screening study, UCLH plans to expand its screening programme to include medical (non-pre-surgical) patients. The rapid screening programme is just one avenue UCLH has pursued to reduce its MRSA rates. Prior to the screening study, the Trust had already introduced intensive hand hygiene campaigns and improved Infection control around intravenous line procedures. UCLH recently became the first institution in the UK to introduce 'infection-resistant' keyboards.

There is a 23 per cent mortality rate among patients with MRSA bacteraemia (bacterial infections of the bloodstream). In the early 1990s, two per cent of Staphylococcus aureus bacteraemias were due to MRSA in the UK; the mean figure is now about 45 per cent and UK rates of MRSA bloodstream infections are among the highest in Europe.

The UK government has set a target that by 2008 all hospitals must reduce infection rates by 50 per cent in comparison to 2003-2004 base rates. However, recent official figures from the Health Protection Agency showed that there has only been a reduction of 20 per cent across all UK hospitals.

The Health Act 2006: Code of practice for the prevention and control of healthcare-associated infections, published by the Department of Health (DOH), states that hospitals should make provisions for pre-admission MRSA screening in addition to Decontamination and isolation of colonised patients. While the DOH does not specify the type of screening that should be used, it does suggest decolonisation of emergency orthopaedic patients and all critical care patients should begin immediately upon admission, unless a rapid screening method is used, owing to the fact that the results for culture-screening will not be known until after the critical period for these patients.

The research study is published in the British Journal of Surgery.
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