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A Retrospective Cohort Study into Acquisition of MRSA and Associated Risk Factors after Implementation of Universal Screening in Scottish Hospitals

Published online by Cambridge University Press:  02 January 2015

E. V. H. van Velzen ,
J. S. Reilly ,
K. Kavanagh ,
A. Leanord ,
G. F. S. Edwards ,
E. K. Girvan ,
I. M. Gould ,
F. M. MacKenzie  and
R. Masterton
E. V. H. van Velzen*
Affiliation:
Health Protection Scotland, Glasgow, United Kingdom European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
J. S. Reilly
Affiliation:
Health Protection Scotland, Glasgow, United Kingdom
K. Kavanagh
Affiliation:
University of Strathclyde, Glasgow, United Kingdom
A. Leanord
Affiliation:
National Health Service (NHS) Greater Glasgow and Clyde, Glasgow, United Kingdom
G. F. S. Edwards
Affiliation:
Scottish MRSA Reference Laboratory, Glasgow, United Kingdom
E. K. Girvan
Affiliation:
Scottish MRSA Reference Laboratory, Glasgow, United Kingdom
I. M. Gould
Affiliation:
NHS Grampian Health Board, Aberdeen, United Kingdom
F. M. MacKenzie
Affiliation:
NHS Grampian Health Board, Aberdeen, United Kingdom
R. Masterton
Affiliation:
NHS Ayrshire and Arran Health Board, Ayrshire, United Kingdom
*
Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, United Kingdom (evhvanvelzen@gmail.com)
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Abstract

Objective.

To estimate the proportion of patients who acquire methicillin-resistant Staphylococcus aureus (MRSA) while in hospital and to identify risk factors associated with acquisition of MRSA.

Design.

Retrospective cohort study.

Patients.

Adult patients discharged from 36 general specialty wards of 2 Scottish hospitals that had implemented universal screening for MRSA on admission.

Methods.

Patients were screened for MRSA on discharge from hospital by using multisite body swabs that were tested by culture. Discharge screening results were linked to admission screening results. Genotyping was undertaken to identify newly acquired MRSA in MRSA-positive patients on admission.

Results.

Of the 5,155 patients screened for MRSA on discharge, 2.9% (95% confidence interval [CI], 2.43–3.34) were found to be positive. In the subcohort screened on both admission and discharge (n = 2,724), 1.3% of all patients acquired MRSA while in hospital (incidence rate, 2.1/1,000 hospital bed-days in this cohort [95% CI, 1.5–2.9]), while 1.3% remained MRSA positive throughout hospital stay. Three risk factors for acquisition of MRSA were identified: age above 64 years, self-reported renal failure, and self-reported presence of open wounds. On a population level, the prevalence of MRSA colonization did not differ between admission and discharge.

Conclusions.

Cross-transmission of MRSA takes place in Scottish hospitals that have implemented universal screening for MRSA. This study reinforces the importance of infection prevention and control measures to prevent MRSA cross-transmission in hospitals; universal screening for MRSA on admission will in itself not be sufficient to reduce the number of MRSA colonizations and subsequent MRSA infections.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 9 , September 2011 , pp. 889 - 896
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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