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Br J Gen Pract. 2010 July 1; 60(576): 533–534.
PMCID: PMC2894386

MRSA screening: is it really necessary in primary care?

Tarique Khan
29 Grantham Road, Sparkbrook, Birmingham, B11 1LU. E-mail: drtariq.khan/at/doctors.org.uk

In a period of economic restrictions within the NHS, the cost of Meticillin Resistant Staphylococcus aureus (MRSA) screening for healthy individuals receiving minor surgical interventions is becoming increasingly difficult to justify; with lack of evidence to support the effectiveness of this intervention.

Reduction in healthcare associated infections, especially MRSA, is a government target and hence a priority for primary care trusts (PCTs). All patients undergoing elective surgery should now be screened and de-colonised of MRSA prior to surgery.5

MRSA colonisation increases the risk of developing infections (ranging from superficial to invasive) following surgery,2,3 that can be difficult and costly to treat, resulting in prolonged hospital stays for affected in-patients.4

In NHS Walsall approximately 3000 patients are currently referred annually for all minor surgery in primary care. We audited the results of MRSA screens from 25 June 2009 to 7 December 2009 for patients undergoing vasectomy/carpel tunnel decompression to assess whether the policy was being adhered to and to make recommendations based on the findings.

The audit found that of the 230 patients screened for MRSA (72 carpel tunnel and 158 vasectomy) only one positive case (nasal swab) was identified from a vasectomy patient.

We calculated the cost of these tests to be approximately £3 each, totalling £690, not taking into account administration, transport, and other related costs.

In an attempt to add to the body of knowledge around screening in primary care we recognise that the financial implications to NHS Walsall are minimal, however, for larger organisations there may be savings if screening activities are reviewed.

The Department of Health reports that 30% and 3% of the general population carry Staph. aureus and MRSA, respectively.1 Although our sample size was small, we found that one patient (0.4%) tested positive for MRSA; this is lower than the predicted value of 3% (approximately seven patients from our population sample).

However, our study population is not representative of the general population as they were offered surgery in primary care, indicating that they are healthier than patients undergoing this intervention in hospital.

Based on our findings we recommend a ‘risk-based approach’ to MRSA screening in primary care as it does not seem effective to screen relatively well patients with no risk factors or evidence of benefit.

In the current economic climate with financial constraints, it will become increasingly difficult to support interventions that are not cost-effective.

REFERENCES

1. Department of Health. A simple guide to MRSA 2007. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_076839.pdf (accessed 11 Jun 2010)
2. Biedendach D, Moet G, Jones R. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002) Diagn Microbiol Infect Dis. 2004;50(1):59–69. [PubMed]
3. Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309–317. [PubMed]
4. Cosgrove SE, Sakoulas G, Perencevich EN, et al. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin infect Dis. 2003;36(1):53–59. [PubMed]
5. Department of Health. MRSA screening — operational guidance. London: DoH; 2008.

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners