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New figures cast doubt on MRSA screening programme

By Lilian Anekwe

The Government's flagship pre-admission MRSA screening programme has been dealt a major blow by new data suggesting fewer than one in ten cases of MRSA infections are found in people admitted for elective procedures.

The first published data found only 7% of all MRSA bloodstream infections were identified in elective admissions – with half of hospital trusts failing to pick up any MRSA infections at all.

All hospitals in England and Scotland introduced compulsory pre-operative screening of patients admitted for non-emergency surgery in April to identify MRSA carriers, a policy which has drawn criticism from GPs who have been left to deal with the burden of decolonising patients with complex resistant infections.

But the Health Protection Agency figures from elective patients admitted over 2008/9 suggest the policy may not be worthwhile due to the tiny fraction of infections detected in elective patients.

Even in the hospital trust with the highest number of infections – Leeds Teaching Hospitals NHS Trust – only 14 cases were recorded. The highest rate seen was 3.98 per 10,000 bed days, at Trafford Healthcare NHS Trust.

‘In the financial year April 2008 to March 2009, a total of 193 reports of MRSA bacteraemia were reported in elective patients, with a rate of 0.3 cases per 10,000 elective bed days,' the HPA report said.

‘A total of 51% NHS acute trusts did not report any elective MRSA bacteraemia. The remaining 49% of trusts reported numbers ranging from one to fourteen.

‘These cases constitute a small proportion, approximately 7%, of the total number of reported MRSA bacteraemia cases in England for the financial year 2008/9.

A spokesperson for the Department of Health said the figures did not reflect carriers identified through screening, and added: ‘Screening is only one of the measures that have contributed to the NHS delivering, and exceeding, the target to halve MRSA bloodstream infections.'

Dr Michael Millar, lead clinical microbiologist at Barts and The London Hospital NHS Trust, said: ‘The Department of Health might argue that there are other sets of information that are not captured in this data. But it's not just about preventing a small number of MRSA infections. You have to think about the consequences for the patients that have been screened.'

‘There's a small benefit of preventing a very small number of cases of MRSA but a lot of people are going to have negative benefits from having this done to them. An enormous amount of money is spent on this – is this the right thing to spend the money on?'

MRSA figures

2,935 - Number of MRSA cases reported in 2008/9
6,421,157 - Total elective bed days in 2008/9
193 – Number of cases detected through elective screening in 2008/9

Source: Health Protection Agency, October 2009

Fewer than one in ten cases of MRSA infections have been detected in people admitted for elective procedures. Fewer than one in ten cases of MRSA infections have been detected in people admitted for elective procedures.

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