Comparison of Systematic Versus Selective Screening for Methicillin‐Resistant Staphylococcus aureus Carriage in a High‐Risk Dermatology Ward

• Published in: Infection control and hospital epidemiology 2000-09, Vol.21 (9), p.583-587
• Main Authors: Girou, Emmanuelle, Azar, Joyce, Wolkenstein, Pierre, Cizeau, Florence, Brun‐Buisson, Christian, Roujeau, Jean‐Claude
• Format: Article
• Language: English
• Subjects: Bacterial diseases; Biological and medical sciences; Cross Infection - diagnosis; Dermatology; Hospital admissions; Hospital Bed Capacity, 500 and over; Hospital units; Hospitalization; Human bacterial diseases; Humans; Infections; Infectious diseases; Lesions; Mass Screening; Medical sciences; Methicillin Resistance; Methicillin resistant staphylococcus aureus; Microbial Sensitivity Tests; Original Articles; Patient Admission; Patient medical history; Risk Factors; Skin; Skin Diseases - microbiology; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - pathogenicity; Wounds and Injuries - microbiology
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/501807

To compare two strategies for screening methicillin-resistant Staphylococcus aureus (MRSA) carriers in a high-risk dermatology ward: systematic screening of all admitted patients versus selective screening of patients at risk. The two strategies were applied prospectively during two consecutive periods. In period A (8.5 months), only patients transferred from other wards, or with a history of prior hospitalization, or presenting chronic wounds or disease with denuded skin were considered at high risk of MRSA carriage and sampled. In period B (7.5 months), all admitted patients were systematically screened. End-points were the number of patients having a MRSA-positive screening sample on admission during period B and having none of the risk factors used in period A, the rate of imported MRSA cases, and the rate of acquired cases. A 1,032-bed university hospital with a 19-bed inpatient dermatology ward, a referral center for toxic epidermal necrolysis and severe extensive dermatoses. The study included 729 dermatology inpatients (370 in period A and 359 in period B). During period A, screening samples were obtained on admission for 30% of patients (77% of the patients at risk) and identified 25 MRSA carriers. During period B, 90.5% of admitted patients were screened, and 26 MRSA carriers were detected on admission; all of these patients belonged to at least one predefined category at risk for carriage. Overall rates of imported and acquired cases were similar between the two periods (6.8% vs 7.5%, and 2.9% vs 2.4%, respectively). A screening strategy targeted to patients at risk of harboring MRSA has similar sensitivity and is more cost-effective than a strategy of systematic screening to identify MRSA carriers on admission.