MRSA SCREENING:

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• MRSA SCREENING
• THEORETICAL VS. PRACTICAL

Nancy Alfieri, March 5, 2008
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(No Transcript)
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Why Screen?

• PROs
• MRSA has increased (in CHR) from 2.2 to
  9.4/10,000 patient days since 2003
• CMRSA (new cases) is rising as quickly as
  health-care associated MRSA in the CHR
• U.S. data indicates an MRSA infection costs an
  additional 35,000 (while other nosocomial
  infections add 14,000 to 15,000)
• Patients with unidentified MRSA act as reservoirs
  for transmission

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• CONs
• Screening programs are expensive
• 100,000 allows 5,000 persons to be screened
  (average of 2.5 screens/person)
• 3 averted infections 105,000
• Isolation precautions challenge systems already
  stretched to capacity

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CHR Universal Screening Pilot Project

• 3 months, 3 units(orthopedic surgery,
  palliative/medicine, medical teaching)
• Methods
• All patients admitted to these units were
  screened
• Prevalence screens conducted prior to beginning
  screening and on termination of the pilot
• Anatomical sites screened were
• Nasal culture
• Z body swab (axilla and torso)
• Up to three wounds
• Suppression CHG bath/shower

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Results

• 89.2 of eligible patients were screened
• PREVALENCE SCREEN RESULTS

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New Cases Admitted During Pilot
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Acquisition of Newly Detected MRSA Positive Cases
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The Last Table is Important! Why?

• An equal number of cases are hospital-acquired
  and community-acquired
• This means up to 44 of the positive patients
  would have been missed using an admission
  screening protocol based on previous
  hospitalization or living in institutional
  settings

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What Did We Learn

• For the CHR, traditional admission screening
  would not capture a large proportion of the
  MRSA-colonized clients
• Medically complex patients with multiple
  co-morbidities and frequent health care
  encounters are to be considered high risk for
  MRSA
• Some surgical patient populations may be low risk

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What did we learn(contd)

• Universal screening is challenging to units
  facing significant staffing shortages
• Housekeeping workload increases as the burden of
  patients on isolation increases
• Suppression regimes may be an effective way to
  decrease transmission risk
• Streamlining screening processes is key to
  sustainability

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Next Steps

• In the CHR we are proposing expansion of the
  universal screening process and staging
  implementation
• Screening programs require regular analysis for
  efficiency and effectiveness
• Screening combined with interventions to reduce
  transmission requires further study

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GO OUT ON A LIMB
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Recommendations

• Go out on a limb, test your population
  appropriately
• Engage the front-line care providers and measure
  workload, transmission/ acquisition rates in
  screening programs
• Question, Question, Question.if the
  screening protocols dont impact nosocomial
  acquisitionthen what?
• Test interventions
• Effective screening specimens
• Decolonization
• Suppression
• Isolation
• Environmental controls
• Hand hygiene