Infection control: National audit tests effectiveness of current MRSA screening policy

Previous national guidelines recommended screening only those patients at the highest risk of carrying or contracting the hospital superbug. But current policy is to screen all elective and emergency admissions at all NHS centres across the country.

However, the limited available evidence in clinical and modelling studies suggests that while this cross-the-board approach costs more than risk-based screening, there is little effect on infection rates.

So, to help inform a decision on the future direction, the Department of Health (DH) has commissioned the Royal Free Hospital, University College London and the Health Protection Agency to carry out an independent review.

The voluntary audit is taking place all this week among acute NHS trusts in England and will look at the implementation, clinical and cost effectiveness, and impact of patient management of current screening policy. It aims to provide:

• Data on the rates of MRSA colonisation detected in different patient groups
• Data on the extra yield from routine admission versus risked-based screening
• Data on the implementation of the screening programme (i.e. what percentage of acute and elective admissions are screened for MRSA)
• Data on the costs of screening (i.e. the laboratory and non laboratory costs of screening and of treating MRSA-positive patients
• A model that could be used by the NHS to predict the effectiveness of different screening strategies for different types of hospital, patient populations, MRSA prevalence levels, and ensure the cost-effectiveness of local screening protocols

Each trust has been asked to provide data on admissions, screening, infection levels and local practice around the eradication of healthcare associated infections.

A DH spokesman said: “Nationally, the DH will review the current MRSA screening policy in the light of evidence provided by the audit. A model for local NHS organisations to determine and develop the most clinically and cost-effective protocols for screening within their organisations will then be developed.”