MRSA Screening in Ambulatory Upper Limb Trauma Day Cases

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Background/Aims Approximately 3% of people in the UK are carriers for meticillin-resistant Staphylococcus aureus. In 2010, the Department of Health and Social Care instigated mandatory screening for surgical patients at significant cost and increased resource demand. An audit performed in a hand surgical unit at Leeds General infirmary showed a 0% rate of positive meticillin-resistant Staphylococcus aureus preoperative screening swabs and meticillin-resistant Staphylococcus aureus associated wound infections on a population of 500 consecutive trauma day cases in 2011. In light of this, routine screening for day case upper limb trauma day cases ceased from July 2012 in Leeds General Infirmary, with significant financial savings. The aims of this study were to re-examine the rates of postoperative meticillin-resistant Staphylococcus aureus wound infections in a second population of hand surgical unit patients after 2 years without routine methicillin-resistant Staphylococcus aureus screening. Methods A retrospective audit of 500 consecutive patients who attended the hand surgery unit for upper limb day case trauma surgery between 1 December 2013 and 30 June 2014 was undertaken. The pattern of injuries sustained, procedures performed, patient demographics and both the incidence and nature of postoperative surgical site infection was examined. Results Overall, 9% had preoperative meticillin-resistant Staphylococcus aureus screening, 0% were positive for meticillin-resistant Staphylococcus aureus. There were no meticillin-resistant Staphylococcus aureus positive postoperative surgical site infections. Conclusions Patients attending for ambulatory hand trauma surgery carry a low risk of being colonised with meticillin-resistant Staphylococcus aureus. The financial saving is estimated to amount to approximately £42 500 per annum for the department – excluding personnel costs.