MRSA screening

MRSA screening of patients is used in order to keep MRSA infection out of hospitals.

Nurses will take swabs from the nose, mouth, skin and groin and submit the sample to a detection test as part of the pre-admission process to establish if a patient is colonised (has bacteria living in and on their bodies) with MRSA.

A hospital decolonisation or suppression routine (removal of bacteria from the body) includes instructing patients on how to remove the bacteria from their bodies using the following:

  1. Antibacterial shampoo and body wash
  2. Antibacterial nasal cream

The Chief Medical Officer summarises what patients and procedures should be considered when taking into account how common MRSA colonisation is in the local patient population served by the hospital:

  1. Pre-operative patients, for example elective orthopaedics, cardiothoracic and neurosurgical, should receive pre-operative screening and decolonisation before admission
  2. Emergency orthopaedic and trauma patients should be screened on admission, while MRSA-positive patients should be decolonised
  3. Intensive care and high dependency unit patients should be screened on admission and at weekly intervals, while all MRSA-positive patients should be decolonised
  4. All renal (kidney) medicine patients should be screened on admission to a dialysis programme and at regular intervals afterwards
  5. Other at risk groups (including patients previously identified as MRSA-positive), all elective surgical patients and oncology/chemotherapy patients should be screened and decolonised, appropriate to local risk of MRSA colonisation
  6. Admissions from high-risk settings (other hospitals, nursing homes) should be screened on the basis of local risk of MRSA colonisation
  7. All emergency admissions should be screened and decolonised, protocols depending on local risk of MRSA colonisation

Usually, a hospital will have a single method for screening. A few will use a slower screening method for non-emergency cases.

Each testing method has its own advantages and disadvantages:

  1. Broth enrichment is the most sensitive test, but takes at least 48 hours. Emergency admissions would not be detected in time to isolate them from other patients
  2. Direct culture is less sensitive than broth enrichment, but takes only 24 to 48 hours. Emergency admissions would not be detected in time to isolate them from other patients
  3. PCR rapid test can only be used for nose samples, but the results come back in 20 hours. The main issue of point-of-care testing is a lack of quality control, so PCR cannot be recommended at present

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