Guidance to help standardise MRSA screening in hospitals is now available, aiming to reduce delays in the surgical pathway and helping to manage demand for preoperative assessment (POA) services.
The guidance has been developed by GIRFT in collaboration with the National Perioperative Collaborative, with input from NHS England’s national clinical directors for perioperative medicine and critical care, and infection prevention and control.
MRSA (Methicillin-Resistant Staphylococcus Aureus), sometimes described as a ‘superbug’, is a type of bacteria that can cause serious infections if it gets inside the body. Official Infection Prevention and Control (IPC) guidance in 2014 introduced enhanced mandatory surveillance for MRSA in hospital, which has resulted in a considerable decrease. However, over time, local protocols have been tailored to individual sites.
GIRFT’s reviews, along with a recent audit and the work of GIRFT’s POA non-medical network, highlighted unwarranted variation around indications for MRSA screening, the mode of swab, and the duration of validity of MRSA tests. This variation is impacting elective recovery, for example by creating repeated patient visits, postponements, or on-the-day cancellations.
The new guidance comes in response to feedback that supplementary guidance would help standardise practice. It is especially important as we move to new models for elective care, such as surgical hubs and mutual aid.
The three suggested actions in the guidance outline:
- which patients should be screened MRSA (e.g. those having surgery in a high-risk specialty, such as neurosurgery, or where the procedure involves the insertion of prosthetic material);
- which sites should be swabbed (the nose and groin/perinium by default, with additional sites screened on a case-by-case basis);
- the duration of validity of an MRSA screen (at least three months for major surgery and up to six months or potentially longer).
The guide also summarises current guidance on suppression therapy and offers advice regarding patients who test positive and negative for MRSA.
It is the third in a series of GIRFT practical guides that aim to support hospital trusts to take a targeted and evidence-based approach to diagnostic testing, avoiding blanket testing policies. The previous two are Guide to preoperative testing: Urine testing before elective urological surgery and Guide to N-terminal prohormone of brain natriuretic peptide (NTproBNP) and Echocardiography.
GIRFT’s national lead for preoperative assessment, Emma McCone, led the group which developed the MRSA screening guidance:
“We are obviously encouraged to see the considerable decrease in incidence of MRSA since enhanced mandatory surveillance began, but the 2014 guidance allows significant room for interpretation locally and we now know that variation has emerged over time which is impacting elective recovery. We hope this guidance helps to remove some of the barriers around POA validity which is often defined by the timing of MRSA screening, and can lead to patients having to make multiple visits to hospital.”
