Point of care universal screening for meticillin-resistant Staphylococcus aureus (MRSA) on admission wards with a low prevalence of MRSA has no additional impact on MRSA acquisition on those wards compared with culture screening: a cluster randomised cross-over trial

TY - JOUR

T1 - Point of care universal screening for meticillin-resistant Staphylococcus aureus (MRSA) on admission wards with a low prevalence of MRSA has no additional impact on MRSA acquisition on those wards compared with culture screening: a cluster randomised cross-over trial

AU - Wu, Pei Jun

AU - Jeyaratnam, Dakshika

AU - Tosas, Olga

AU - Cooper, Ben S.

AU - French, Gary L.

PY - 2016/8/24

Y1 - 2016/8/24

N2 - SummaryBackgroundRapid point of care MRSA screening (POCS) at hospital admission may be associated with a reduction in MRSA acquisition rates when compared with slower laboratory-based methods. We conducted a clinical trial to test this proposal.MethodsA cluster randomised cross-over trial in four admission wards of an acute London tertiary care hospital. Polymerase chain reaction based POCS screening was compared with conventional culture screening. Patients were screened on ward admission and discharge and the MRSA acquisition rate on the admission wards was calculated as the primary outcome measure.Results10,017 patients were included; 4,978 in the control arm, 5,039 in the POCS arm. The MRSA carriage rate on admission was 1.7%. POCS reduced the median reporting time from 40.4 to 3.7 hours (P<0.001). MRSA was acquired on the admission wards by 23 (0.46%) patients in the control arm and 24 (0.48%) in the intervention arm, acquisition rates of 5.39 and 4.60 per 1000 days respectively. After taking account of predefined confounding factors, the adjusted incidence rate ratio (IRR) for change in trend for MRSA acquisition was 0.961 (95% CI 0.766-1.206).The adjusted IRR for step change for MRSA acquisition was 0.98 (0.304 - 3.162).ConclusionsPOCS produces a significantly faster result but has no effect on MRSA acquisition on admission wards compared with culture screening. Where compliance with infection prevention and control is high and MRSA carriage is low, POCS has no additional impact on MRSA acquisition rates over the first 1-4 days of admission compared with conventional culture screening.

AB - SummaryBackgroundRapid point of care MRSA screening (POCS) at hospital admission may be associated with a reduction in MRSA acquisition rates when compared with slower laboratory-based methods. We conducted a clinical trial to test this proposal.MethodsA cluster randomised cross-over trial in four admission wards of an acute London tertiary care hospital. Polymerase chain reaction based POCS screening was compared with conventional culture screening. Patients were screened on ward admission and discharge and the MRSA acquisition rate on the admission wards was calculated as the primary outcome measure.Results10,017 patients were included; 4,978 in the control arm, 5,039 in the POCS arm. The MRSA carriage rate on admission was 1.7%. POCS reduced the median reporting time from 40.4 to 3.7 hours (P<0.001). MRSA was acquired on the admission wards by 23 (0.46%) patients in the control arm and 24 (0.48%) in the intervention arm, acquisition rates of 5.39 and 4.60 per 1000 days respectively. After taking account of predefined confounding factors, the adjusted incidence rate ratio (IRR) for change in trend for MRSA acquisition was 0.961 (95% CI 0.766-1.206).The adjusted IRR for step change for MRSA acquisition was 0.98 (0.304 - 3.162).ConclusionsPOCS produces a significantly faster result but has no effect on MRSA acquisition on admission wards compared with culture screening. Where compliance with infection prevention and control is high and MRSA carriage is low, POCS has no additional impact on MRSA acquisition rates over the first 1-4 days of admission compared with conventional culture screening.

KW - Meticillin resistant Staphylococcus aureus

KW - MRSA

KW - screening

KW - point of care

KW - rapid screening

U2 - 10.1016/j.jhin.2016.08.017

DO - 10.1016/j.jhin.2016.08.017

M3 - Article

SN - 0195-6701

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

ER -