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MRSA screening usefulness in doubt

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Doubts have been cast over government plans to introduce universal MRSA screening for inpatients after a large Swiss study found it had little effect on infection rates.

Over the next three years the Department of Health wants all NHS patients to be screened for MRSA on admission to hospital. But University of Geneva researchers who studied nearly 22,000 surgical patients at a teaching hospital found no significant difference in infection rates between those who were screened and those who were not.

Over 18 months patients in an intervention group received rapid screening on admission plus standard infection control measures, while a control group received standard infection control measures only.

The researchers found that 93 patients in the screening group developed MRSA while in hospital, compared with 76 in the control group.

Lead author Stephan Harbarth, epidemiologist at University of Geneva Hospitals, said: ‘The trial did not show an added benefit for widespread rapid screening on admission compared with standard MRSA control alone.

‘To increase effectiveness, MRSA screening could be targeted to surgical patients who undergo elective procedures with a high risk of MRSA infection,’ he added.

Judy Potter, president of the Infection Prevention Society, said: ‘Screening is complex to get right – one-off screening will not identify all carriers [of MRSA], and identifying carriers will not necessarily reduce the rate of infection.

‘Although screening may be useful in areas where there is a high risk of infection, plans to introduce universal screening are not based on any research that shows it will reduce rates of MRSA,’ she added.

But a Department of Health spokesperson said plans to screen all patients would go ahead. ‘MRSA screening is one part of a range of measures needed to ensure good hygiene and to drive down infection rates,’ he said. ‘Our strategy demonstrates the comprehensive approach required across the NHS.’

Journal of the American Medical Association (2008) 299: 1149–1157

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