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| Source: NHS.UK |
The study was a large one-year prospective cohort study of MRSA screening was carried out in six acute hospitals in NHS Scotland, incorporating 81,438 admissions. Outcomes (MRSA colonization and infection rates) were subjected to multivariable analyses, and trends before and after implementation of screening were compared.
MRSA colonization prevalence decreased from 5.5% to 3.5% by month 12 of the study (P < 0.0001). Colonization was associated with the number of admissions per patient, specialty of admission, age, and source of admission (home, other hospital or care home). Patients who were MRSA screen positive on admission were 12 - 18 times to develop and MRSA infection. MRSA infections (7.5 per 1000 inpatient-days overall) also reduced significantly over the study year (P = 0.0209).
So universal screening for MRSA in Scottish Hospitals resulted in decreased MRSA colonization and disease burden? Possibly. As with many similar studies, it is difficult to control for the impact of confounders such as hand hygiene, chlorhexidine bathing of patients, invasive devices bundles, head or bed elevation of patients on ventilators or any other infection prevention intervention that could have impacted the MRSA rates.
The authors noted that there were no changes in MSSA infections during the study time. What about other pathogens? What about the overall rates of device associated infections across the ICUs? We have a different perspective on active surveillance and detection and have been able to reduce MRSA infections in an ICU without employing that strategy.
I feel that infection prevention efforts, especially if implemented universally, are best judged in toto. I see limited benefit and value in focusing tremendous resources on a single pathogen, which causes the minority of hospital acquired infections, if no commensurate reduction is seen across other pathogens and infections.
