ICS Ltd. MRSA - Screening Patients for MRSA

Page updated 30 April 2007

Screening patients for MRSA

Screening for MRSA is not 100% sensitive. A carrier may have undetectably low carriage which manifests itself only after antibiotic treatment or stress such as surgery. It is, however, considered worth screening before major surgery in order to be able direct chemoprophylaxis and therapy for post operative infection.
Which patients are screened for MRSA on admission?

Patients for major elective surgery

Patients for planned major surgery should be screened (nose and wounds) preferably in a pre-surgery outpatient clinic.
"Major" surgery includes cardiothoracic, vascular, orthopaedic (implant), neurosurgical and intra-abdominal surgery.
If screening is performed just before surgery, then the results will be available in the post-operative phase.
If found to be a carrier of MRSA pre-surgery, the operation should be deferred and patients should embark on the Staphylococcal Decontamination Protocol continuing until the date of surgery. The protocol should be started within 5 days before the intended date of surgery. The patient should not stay in hospital during this period.
For patients requiring surgery, please inform theatre staff. Patient should be last on the list (See Section on Infection Control Guidelines for Operating Theatres ).
Surgical prophylaxis should be modified if a patient is known to be colonised with MRSA

Patients admitted to Intensive Care Units

Patients admitted to Intensive Care Units should be screened for MRSA on admission.
Patients admitted from nursing / residential homes and other NHS facilities should be screened for MRSA on admission.

NOTE: Screening will not detect all carriers of MRSA

Take swabs from nose only; moisten swabs with transport medium; swab nose (one swab to both nostrils)
Send with one request form which states "MRSA NOSE SCREEN"
Swab any WOUNDS AND LESIONS; send with a separate Request Form requesting "culture and sensitivity"; (these will be processed for any significant bacteria)
Other sites may be screened for study purposes
Screening must not be done while the patient is on a 'Staphylococcal Decontamination Protocol'

Repeat screening of nose and wounds is only done after attempted MRSA decontamination (no sooner than 48 hours after stopping the protocol), otherwise, it should be assumed that a patient colonised MRSA remains so for the duration of an admission.
It may be considered worth screening all patients in special units such as ICU on a regular basis.
Repeat screening of MRSA patients should be 7 days apart.
Three consecutive sets of negative screens would imply that the patient may have cleared the organism.