J Hosp Infect. 2021 Mar 31:S0195-6701(21)00145-6. doi: 10.1016/j.jhin.2021.03.024. Online ahead of print.
INTRODUCTION: Despite a perception that meticillin-resistant Staphylococcus aureus (MRSA) is now under control in developed nations, global prevalence remains high, even increasing in some regions. Universal admission screening and decolonisation has been instituted by some hospitals to attempt control but the practice remains controversial.
METHODS: In 2014, Mater Dei Hospital in Malta introduced a universal admission screening policy, utilising a novel, centralised and customised approach to achieve high compliance and low cost. Admissions are nasally screened by designated staff using chromogenic media, irrespective of risk factors. Carriers are decolonised without concurrent isolation or contact precautions. We performed longitudinal, quasi-experimental, evaluation, using time series analysis to analyse the impact of the intervention on MRSA proportions in clinical S. aureus isolates (%MRSA) and incidence per 1000 bed-days (BD). We also attempted a cost-utility analysis to identify approximate Quality Adjusted Life Years (QALY) gained.
RESULTS: A transfer function model approach concluded that the intervention had a significant effect on both %MRSA and incidence. Six years following its introduction, the screening programme had produced an overall 43% long-term reduction in %MRSA from pre-screening levels (R2=0.687; BIC=4.063), translating to a decrease in incidence of approximately 0.56 cases/1000BD (R2=0.633, BIC=-3.063). No correlation was identified with antibiotic or alcohol hand-rub consumption. The yearly cost-benefit of the programme was calculated at €1058 per QALY gain per year.
CONCLUSION: The universal admission screening and decolonisation intervention was successful and cost-effective in our high-endemic setting. It facilitated improvement in MRSA prevalence, achieving reduction levels rarely reported by Mediterranean hospitals.