Question mark over value of elective MRSA screening

The findings have prompted infection control nurses to question the validity of the government’s mandatory policy to screen all elective admissions for MRSA, introduced in England in March this year.

Nursing Times asked 20 acute trusts for details about how many patients they had screened, the percentage that had tested positive and how much the process had cost so far. Nursing Times received replies from 12 trusts, of which four did not provide financial information.

The eight trusts that did provide cost data had spent a combined total of £2.4m on MRSA screening since the national policy was introduced. But of the 197,000 patients screened only around 2 per cent tested positive.

Leeds Teaching Hospitals NHS Trust spent £940,000 on building, equipment and staffing costs – yet only 2.6 per cent of the 18,697 patients screened tested positive for MRSA. Only 0.9 per cent of the 13,500 elective patients screened at Royal Devon and Exeter NHS Foundation Trust tested positive, but it cost the trust almost £300,000.

Infection Prevention Society president Martin Kiernan, a nurse consultant in infection prevention and control at Southport and Ormskirk NHS Trust, said the NHS needed to look at elective screening to see if it was “really worth the cost”.

“Elective screening was a step into the unknown, but many [infection control nurses] suspected it wasn’t a key area to focus on,” said Mr Kiernan.

He said it put a lot of resources into patients that had little chance to spread infection because they tended to be in and out of hospital quickly with minimal contact with other patients.

“It is still too early to say whether elective screening should be withdrawn but concentrating on emergency admissions, where most of the MRSA bacteraemia come from, would’ve likely borne more fruit,” Mr Kiernan told Nursing Times.

He added that individual actions by frontline nurses, rather than government drives such as the “deep clean” and the screening programme, had been most effective in bringing down MRSA rates. 

“A lot of the improvement is down to nurses’ vigilance and keenness to drive improvements. The NHS is moving itself forward on this agenda without waiting to be told what needs to be done,” he said.

Mandatory MRSA screening is set to be extended to include emergencies from next year, with a deadline of March 2011, though some trusts have already started to do this.

Guy’s and St Thomas’s NHS Foundation Trust in London screens all admissions for MRSA, including emergencies, and University Hospitals Bristol NHS Foundation Trust screens emergency admissions on a risk assessment basis.

The Scottish Government announced earlier this month that it would also be introducing MRSA screening for elective patients, starting with ten hospitals in NHS Greater Glasgow and Clyde.

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