Cervical screening

This issue of Health Matters focuses on making cervical screening more accessible.

This latest edition of Health Matters aims to address the decline in cervical screening attendance by presenting recommendations that can help increase access to screening and awareness of cervical cancer.

Despite the success of the programme, screening coverage has fallen over the last 10 years and attendance is now at a 19-year low. Coverage is going down across all age groups.

pack of infographics  is available in support of this campaign

cerv

Image source: http://www.gov.uk

Related case studies:

Improving cervical screening in Trafford: One Minute campaign

GP surgery initiatives boost cervical screening uptake

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Screening programmes | Childhood flu vaccination

Public Health England has updated the following documents:

 

Screening test recommendations for methicillin-resistant Staphylococcus aureus surveillance practices

Whittington, M.D. et al. American Journal of Infection Control. Published online: 23 January 2017

Highlights: 

  • Rapid screening tests reduce unnecessary surveillance costs.
  • Using polymerase chain reaction with universal preemptive isolation minimizes total costs.
  • Using chromogenic agar 24-hour with targeted isolation minimizes total costs.
  • Although polymerase chain reaction minimized inappropriate costs, the added cost per test was only offset with universal preemptive isolation.

Read the full abstract here

UK NSC evidence review process

This document describes the process used by the UK National Screening Committee (UK NSC) to review the evidence relating to the introduction, modification and cessation of national population screening programmes.

The process set out in the document builds on the UK NSC’s previous practice and will be revisited and refined in winter 2016 following:

  • the pilot of the annual call for new topics
  • further work on the UK NSC’s approach to development of rapid reviews
  • completion of a statement on cost effectiveness assessments
  • completion of a framework for consideration of ethical, social and legal issues relating to screening

Overall UK NSC evidence review process:

new_review_flowchart_2

Image source: http://www.gov.uk/

Reduction in methicillin-resistant Staphylococcus aureus colonisation: impact of a screening and decolonisation programme

Garvey, M.I. et al. Journal of Infection Prevention. Published online: 4 August 2016

https://www.flickr.com/photos/wellcomeimages/16003100451/in/photolist-qo95e2-fCw4hb-53wmHs-58CKUe-cw4Wfq-cw4UMo-cw4WL3-cw4VJU-7ojVRv-4CaQEw-4C6xeT-EU6nC-4CaQLJ-q6Lo13-qoj7iX-4CaQDu-EU4Nk-zpiJyu-4CaQMY-qm32Db-j4vREz-or2Sbx-oHuHUf-j4MspC-9y4sDM-or32x7-dQjFSx-a4RLq5-6JBQwo-bpzxT4-iQPVjT-oHuBLJ-or2TEV-oY1BkX-bpCfQR-fN98g7-4CaQCA-4C6xnp-4C6xoc-4C6xmt-4C6xji-fzTQ3p-9RQsFL-7uoVdt-4bAWxg-oHfG5k-DEvM97-9y7kCs-9TwwGL-9TwvXh

Image source: Annie Cavanagh – Wellcome Images // CC BY-NC-ND 4.0

Patients in care homes are often at ‘high risk’ of being methicillin-resistant Staphylococcus aureus (MRSA) colonised. Here we report the prevalence of MRSA, the effect of MRSA screening and decolonisation in Wolverhampton care-home residents.

Eighty-two care homes (1665 residents) were screened for MRSA, three times at 6-monthly intervals (referred to as phases one, two and three). Screening and decolonisation of MRSA-colonised residents led to a reduction in the prevalence of MRSA from 8.7% in phase one, 6.3% in phase 2 and 4.7% in phase three.

Overall, the study suggests that care-home facilities in Wolverhampton are a significant reservoir for MRSA; screening and decolonisation has reduced the risk to residents going for procedures and has indirectly impacted on MRSA rates in the acute Trust.

Read the abstract here

 

Staphylococcus aureus and surgical site infection. The benefit of screening and decolonization before surgery

Humphreys, H. et al. Journal of Hospital Infection. Published online: 18 June 2016

Image shows Staphylococcus aureus on ChromID CPS chromogenic agar. Isolate from a urine sample from a 45 year old catheterised male awaiting surgery for a bladder stone.

Surgical site infections (SSIs) are amongst the most common healthcare-associated infections and significantly contribute to patient morbidity and healthcare costs. Staphylococcus aureus is the most common microbial cause.

The epidemiology of S. aureus is changing, with the dissemination of newer clones and the emergence of mupirocin resistance. The prevention and control of SSIs is multi-modal and we have reviewed the evidence for the value of screening for nasal carriage of S. aureus and the subsequent decolonization of patients pre-operatively who are positive. Pre-operative screening, using culture- or molecular-based methods and the subsequent decolonization of patients positive for methicillin-susceptible S. aureus and methicillin resistant S. aureus (MRSA) reduces SSI and hospital stay. This applies especially to major clean surgery, such as cardiothoracic and orthopaedic, involving the insertion of implanted devices.

However, it requires a multi-disciplinary approach coupled with patient education. Universal decolonization pre-operatively without screening for S. aureus potentially compromises the capacity to monitor for the emergence of new clones of S. aureus, contributes to mupirocin resistance, and prevents the adjustment of surgical prophylaxis for MRSA, i.e. the replacement of a beta-lactam agent with a glycopeptides or alternative.

Read the abstract here

What should we do NOW? Review of a large NHS Trust’s meticillin-resistant Staphylococcus aureus screening

Smith, S.J. et al.Journal of Hospital Infection. Published online: 13 May 2016

Universal meticillin-resistant Staphylococcus aureus (MRSA) screening has been in effect since 2010. MRSA bacteraemia rates have declined substantially, with continuing low MRSA prevalence in hospitals.1 In 2013, the UK Department of Health (DH) commissioned a review of MRSA screening ‒ The National One Week prevalence audit (NOW) ‒ which reviewed the cost-effectiveness of a variety of screening strategies.2Modelling studies determined that the current practice of universal MRSA screening was the least cost-effective and that current compliance with screening was low at 65.7%.

Read the abstract here