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

Published online by Cambridge University Press:  02 January 2015

Emmanuelle Girou ,
Joyce Azar ,
Pierre Wolkenstein ,
Florence Cizeau ,
Christian Brun-Buisson  and
Jean-Claude Roujeau
Emmanuelle Girou
Affiliation:
Unité d'Hygiène et Prévention de l'Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Joyce Azar
Affiliation:
Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Pierre Wolkenstein
Affiliation:
Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Florence Cizeau
Affiliation:
Unité d'Hygiène et Prévention de l'Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Christian Brun-Buisson*
Affiliation:
Unité d'Hygiène et Prévention de l'Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
Jean-Claude Roujeau
Affiliation:
Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris XII, Créteil, France
*
Unité d'Hygiène et Prévention de l'Infection, CHU Henri Mondor, 94010 Créteil, France
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Abstract

Objective:

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.

Design:

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.

Setting:

A 1,032-bed university hospital with a 19-bed inpatient dermatology ward, a referral center for toxic epidermal necrolysis and severe extensive dermatoses.

Patients:

The study included 729 dermatology inpatients (370 in period A and 359 in period B).

Results:

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).

Conclusions:

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 9 , September 2000 , pp. 583 - 587
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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