Health Technology Assessment Report 9, Screening for MRSA (PDF, 1.44MB, 3min 35secs)
About this report
Recent UK guidelines provide contradictory recommendations on the MRSA screening process and those groups of patients to be targeted for screening. As a result, this HTA was commissioned to consider the different MRSA screening strategies and appropriate management of patients found to be colonised. This work only considered the screening of patients admitted to acute hospital inpatient care, although it is recognised that MRSA is a problem within long stay and other community healthcare settings.
Background
A major aspect of controlling the spread of MRSA is screening to identify colonised or infected patients, and then managing them to reduce the risk of MRSA transmission to other individuals. Screening involves taking swabs, and then carrying out laboratory analysis of these samples. The approach of screening all patients for MRSA colonisation was advocated by early guidelines. However, as the problem has grown, such an approach has been suggested to be impractical, and increasingly screening is targeted on the basis of a risk assessment of the likelihood of MRSA carriage.
Results and conclusions
It is clear from the results of the model presented that systematic screening of patients on admission to hospital and isolation of those found to be colonised with MRSA will be effective in reducing the prevalence of MRSA colonisation within the patient population and the incidence of MRSA infection. The extent to which MRSA prevalence can be reduced, and the time to reach low prevalences will depend on the screening strategy adopted. However, even the least costly strategy modelled, where only patients being admitted to high-risk specialty units are screened, should result in prevalence being reduced from around 7% prior to the introduction of screening to 1.5% one year after introduction of the strategy.
A summary of the recommendations contained within the HTA report is available here
Recommended advice for implementation
Clinical and cost effectiveness model
Following publication of the HTA report additional work was undertaken by Simulistics Limited to build a ‘sample’ model, which is freely available to any interested parties. This model, together with accompanying documentation, is available on the Simulistics website http://www.simulistics.com/projects/mrsa/index.htm. Please note that this version is for demonstration purposes only and does not represent the model on which the assumptions within the HTA are based.
Understanding our Advice
Equality & Diversity
NHS QIS is committed to equality and diversity. This document, and the research on which it is based, have been assessed for any likely impact on the six equality groups defined by age, gender, race/ethnicity, religion/faith, disability and sexual orientation. Details of the equality and diversity impact assessment are available here
Further information
For further information, or to receive a copy of the published report, please contact Doreen Pedlar at Doreen.Pedlar@nhs.net.
Useful links
http://www.elib.scot.nhs.uk/portal/hai/pages/index.aspx
http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/19529/2005
