In response to a series of MRSA related post operative complications a policy of pre admission screening and in hospital quarantine was implemented. A course of community eradication therapy prior to admission was instituted where appropriate but patients were not denied admission on the basis of their MRSA status. We have audited the clinical effects of this prevention policy.
All MRSA positive cultures were identified from 989 consecutive patients undergoing thoracic surgery in a single surgeon practice. Two distinct 18 months periods, before and after the introduction of the policy were compared. The rate of clinically significant infection; ITU admission and mortality due to MRSA were recorded. Clinically significant infection was defined as that treated with antibiotics in the presence of a positive culture with either leukocytosis, pyrexia or clinical evidence of infection.
This policy has reduced the risk of significant, post-operative, nosocomial MRSA infection from 6.9% to 2.0% (see tableTotalWoundPneumoniaPleural empyemaPre (n=496)34 (6.9%)25 (5.0%)14 (2.8%)5 (1.0%)Post (n=493)10 (2%)6 (1.2%)5 (1.0%)3 (0.6%)χ20.00020.00050.03NS). However the rate of ITU admission [6 (1.2%) vs 6 (1.2%)] and mortality [6 (1.2%) vs 5(1.0%)] due to MRSA infection was not significantly different in the two periods. The major reservoir of MRSA import onto our ward was from interhospital transfers (32% MRSA carriers) and patients transferred back to our ward from intensive care (31% carriers). Only 1.6% of patients screened as outpatients before admission were found to be carriers.
The implementation of this MRSA prevention policy has been justified by clinical benefits although severe infection remains a life threatening complication.
A greater suspicion of MRSA carriage and presumption of carriage could add significant value to current MRSA prevention guidelines.
J.E. Pilling, None.