MRSA screening in ambulatory upper limb trauma day cases

Abstract

Aims: Approximately 3% of the UK population are carriers for methicillin-resistant Staphylococcus aureus (MRSA). The NHS set a target of reducing MRSA nosocomial infections by 20% in 2012/13. The Department of Health instigated mandatory universal screening for elective and trauma surgery at significant cost and increased resource demand. Patients presenting to our service with simple upper limb trauma requiring day case surgical intervention are included in mandatory universal MRSA screening, despite being discharged post-operatively before any screening result is known. The aim of this study was to examine the effectiveness of mandatory screening in our patient cohort. Methods: We undertook a retrospective audit of 500 consecutive day case upper limb trauma cases that were managed in our hand unit between 1 May and 31 October 2011. Patient demographics, injury, operative intervention, pre-operative MRSA screening result and post-operative wound swab results were examined. Patients with frankly infective conditions such as abscesses and flexor tenosynovitis were excluded. Results: 78% of our patients were male. 91% were less than 60 years old. 98% of patients had a pre-operative MRSA screening swab. None were positive. 2% had positive post-operative swabs for organisms other than MRSA. Conclusion: We approached our trust and successfully proposed that young, ambulatory, day-case upper limb trauma patients be exempt from mandatory screening. At an average throughput of 1000 cases per annum and an estimated cost of £42.50 per MRSA screen, excluding this cohort of patients from mandatory screening has saved approximately £42 500. The true savings would be likely far greater if applied to similar cohorts across the trust, bringing with it a reduction in screening infrastructure.