1. Joy, Subhashni D. Singh

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According to this study:


* Universal screening for MRSA didn't decrease risk of nosocomial infection.



Universal screening for methicillin-resistant Staphylococcus aureus (MRSA) has been recommended to decrease the risk of nosocomial infection. The authors of this prospective crossover study tested this recommendation using 12 surgical wards at the University of Geneva Hospitals. Wards followed either the intervention or the control protocol for nine months, and then they followed the other protocol for another nine months.


Within both protocols, the hospital followed standard infection control measures: isolating patients who carried MRSA, using equipment with only that patient, administering antibiotic prophylaxis before surgery, and using a nasal spray and body wash to decrease topical colonization. During the intervention period, patients were also screened at admission using an early detection technique (quantitative polymerase chain reaction). Trained infection control staff monitored the wards at least twice weekly.


The control group included 10,910 patients. Of the 10,844 patients in the intervention group, 10,193 were screened; of those, 515 patients (5.1%) were identified as MRSA carriers. During the intervention and control periods, similar numbers of patients developed nosocomial infection: 93 in the intervention group and 76 in the control group. Of the 93 who developed infection during the intervention periods and were screened at admission, 23 had already known they were carriers and 17 were identified as carriers upon screening; 53 had had negative screening results and had acquired their first infection in the hospital. Of the 70 patients with surgical site infections in the intervention group, 41 (59%) didn't display signs of MRSA before surgery. Prophylaxis was provided during surgery to about two-thirds of the remaining 29 patients (who had previously had MRSA but also acquired a surgical site infection).


The authors concluded that universal screening for MRSA isn't cost effective and didn't decrease the incidence of nosocomial or surgical site infection, compared with standard infection control. They suggest that targeted screening for those with a high risk of infection may be more effective than universal screening.


Harbarth S, et al. JAMA 2008;229(10):1149-57.