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

 

Infectious diseases in pregnancy screening: clinical guidance

Information for healthcare professionals providing the NHS infectious diseases in pregnancy screening (IDPS) programme.

These documents explain the procedures for providing NHS infectious diseases in pregnancy screening (IDPS) in England, to ensure services meet the national standards.

Care pathways

See the typical care pathway for pregnant women screened for infectious diseases in pregnancy.

Service specifications

Infectious diseases in pregnancy screening professionals must use thenational service specifications in conjunction with these documents, to ensure service consistency in England.

KPIs

The national quality assurance team uses key performance indicators (KPIs)to measure the performance of the antenatal and newborn screening programmes. Following the KPIs and standards for each programme ensures that all women receive an equitable screening experience.

Infectious diseases in pregnancy screening (IDPS): programme guidance

  1. Infectious diseases in pregnancy screening programme: laboratory handbook

Universal vs Risk Factor Screening for Methicillin-Resistant Staphylococcus aureus in a Large Multicenter Tertiary Care Facility in Canada

Infect. Control Hosp. Epidemiol. 2015;00(0):1–8

Abstract

OBJECTIVE To assess the clinical effectiveness of a universal screening program compared with a risk factor–based program in reducing the rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) among admitted patients at the Ottawa Hospital.

DESIGN Quasi-experimental study.

SETTING Ottawa Hospital, a multicenter tertiary care facility with 3 main campuses, approximately 47,000 admissions per year, and 1,200 beds.

METHODS From January 1, 2006 through December 31, 2007 (24 months), admitted patients underwent risk factor–based MRSA screening. From January 1, 2008 through August 31, 2009 (20 months), all patients admitted underwent universal MRSA screening. To measure the effectiveness of this intervention, segmented regression modeling was used to examine monthly nosocomial MRSA incidence rates per 100,000 patient-days before and during the intervention period. To assess secular trends, nosocomial Clostridium difficile infection, mupirocin prescriptions, and regional MRSA rates were investigated as controls.

RESULTS The nosocomial MRSA incidence rate was 46.79 cases per 100,000 patient-days, with no significant differences before and after intervention. The MRSA detection rate per 1,000 admissions increased from 9.8 during risk factor–based screening to 26.2 during universal screening. A total of 644 new nosocomial MRSA cases were observed in 1,448,488 patient-days, 323 during risk factor–based screening and 321 during universal screening. Secular trends in C. difficile infection rates and mupirocin prescriptions remained stable after the intervention whereas population-level MRSA rates decreased.

CONCLUSION At Ottawa Hospital, the introduction of universal MRSA admission screening did not significantly affect the rates of nosocomial MRSA compared with risk factor–based screening.