532 Implementation of Universal Screening on a National Scale

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Sally Stewart, MSc , NHS Health Protection Scotland, Glasgow, United Kingdom
Jacqui Reilly , NHS Health Protection Scotland, Glasgow, United Kingdom
Gwen Allardice, PhD , NHS Health Protection Scotland, Glasgow, United Kingdom
Smith Ann, MPH , NHS Health Protection Scotland, Glasgow, United Kingdom
Ian Gould, MD , Grampian Health Board, Aberdeen, Scotland
Robert Masterton, MD , Ayrshire and Arran Health Board, Ayr, Scotland
Craig Williams, MD , Greater Glasgow and Clyde Health Board, Glasgow, Scotland
Background: In Scotland a health technology assessment (HTA) developed a model to compare various MRSA screening strategies. It concluded that universal screening of all patients using a chromogenic agar laboratory test provided the best clinical benefit for the investment. A practical implementation study was recommended due to the limitations of the literature on which the model was based.
Objective: The objectives of the research were to test the assumptions of the HTA and inform the Scottish Government whether MRSA screening was considered to be an approach which could be recommended to try and reduce MRSA colonization and infection in Scottish acute care.
Methods: A prospective cohort study was undertaken within three health board regions including six hospitals. Universal MRSA screening for all hospital admissions was implemented. Those found positive were decolonized and isolated or cohorted where possible. The results of the implementation were reviewed in terms of clinical effectiveness, cost effectiveness, staff and patient acceptability and organizational issues. Details on each admission including MRSA status on admission, decolonization and isolation when it was undertaken and the outcome of MRSA infection were recorded of all admission over one year from July 2009. Data from mandatory surveillance programmes was reviewed to monitor mupirocin resistance. Multivariate logistic regression was undertaken to analyze the factors which significantly affected MRSA colonization.
Results: A total of 81,438 admissions were included in the cohort and followed up to discharge.  Implementation of universal screening is possible; uptake of 85% of admissions within the year was achieved. The results indicated that colonization varied between age groups and specialties. Patients with repeat admissions were found to be more likely to be colonized. The proportion of patients who were successfully decolonized was low. The protocol was acceptable to staff, patients and the public.
Conclusions: Due to the short length of stay and long turn around time for the test, the proportion of patients who received their MRSA results before discharge was low. Despite the acceptability of the study, the logistical issues and turn around of the chromogenic test have meant that the ability to undertake the protocol recommended within the original model was found to be limited. Universal MRSA screening was found to be possible to implement however, questions remain over its effectiveness in reducing infection during hospital stay.