The way to prevent MRSA transmission in hospitals is to screen high-risk patients admitted to the hospital for MRSA, and then isolate those who screen positive.
Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly rampant, and its infection spreads almost all over the world. Together with AIDS and hepatitis B, it has become the three most difficult infectious diseases in the world. How to prevent and controlling MRSA has become a problem that cannot be ignored.
The long-term treatment of MRSA infection, in addition to the direct economic burden on patients, will also generate some indirect costs, such as isolation, disinfection and so on. Strict detection and control measures should be proposed in response to the prevalence of MRSA. MRSA screening is an important part of this.
MRSA is one of the major pathogens of nosocomial infections. The epidemiology and microbiology of MRSA vary around the world and provide an important basis for developing strategies to prevent and control its infection.
MRSA can be classified into hospital-associated, community-acquired, community-associated, and livestock-associated. Community-associated and livestock-associated MRSA are relatively recent, and this article focuses on hospital-associated MRSA.
At present, the optimal screening strategy and expansion scope of MRSA colonized or infected patients are still controversial.
Which patients should be screened for MRSA?
A throat-flocked swab for influenza is more accurate. Throat swab testing for influenza is very fast, economical, and simple.
Proponents of universal screening claim that this strategy significantly increases the detection rate of MRSA carriers. Others argue that universal screening protocols are too expensive and that patients with risk factors for MRSA colonization should be tested.
Universal screening may make it easier to identify MRSA carriers and those at high risk of infection.
The Scottish Health Technology Assessment study showed that universal screening as part of a programme to control MRSA is potentially effective and cost-effective.
The MRSA screening clinical risk assessment questionnaire in this study included the following questions:
(1) Does the patient have a history of MRSA colonization or infection?
(2) Where has the patient been other than his own home?
(3) Did the patient have wounds or ulcers, and whether there were prostheses or medical implants in the body before admission?
But then a large prospective study including nearly 70,000 patients showed that screening all patients admitted to “high-risk” specialties (intensive care, orthopedics, nephrology, vascular surgery, cardiothoracic surgery), based on the above Targeted screening of other hospital admissions for the three questions, combined with clinical risk assessment, can achieve similar detection rates and significantly reduce costs.
Although high in-hospital prevalence is associated with MRSA, key risk factors may vary by country.
Risk factors for MRSA colonization in adults in emergency care settings:
(1) Hospitalized in the past 24 months.
(2) a long-term care facility or rehabilitation facility within the past 18 months.
(3) an intensive care unit in the past 5 years.
(4) In-hospital transfer.
(5) Received surgical intervention within the past 60 months.
(6) Indwelling urinary catheter.
(7) Antibiotics used in the past 12 months.
(8) There is skin damage.
(9) History of MRSA colonization in the past.
(10) Chronic health comorbidity assessment grade C or D (patient severely restricted in activity due to chronic disease or bedridden).
(11) The presence of terminal disease.
(12) Male.
When should MRSA screening begin?
Eligibility for screening of all other admitted patients should be based on local policy and screening as early as possible. Ensure that appropriate interventions are applied as soon as possible to reduce the risk of infection in the patient and avoid infecting others.
How to screen for MRSA?
A nasopharyngeal culture is a test that examines a sample of secretions from the uppermost part of the throat, behind the nose,
Standard screening swabs should include (a) nasal and perineal swabs or (b) nasal and pharyngeal swabs.
(1) The optimal protocol and screening range for MRSA screening are still controversial.
(2) Clinicians must understand and implement local MRSA colonization patient screening and management policies.
(3) Standard screening swabs should include (a) nasal and perineal swabs or (b) nasal and pharyngeal swabs as a minimum screening to identify colonized or infected patients. For whom subsequent Manage to reduce the spread of MRSA, including close contact protection, decolonization, and isolation.
(4) Time boundaries should be provided for the acquisition of screening results so that effective interventions minimize the risk of infection and transmission to others.
To sum up, it is suggested that in relatively underdeveloped medical institutions, we may directly carry out decolonization interventions for high-risk groups, and perhaps do not need to do the screening. Because the cost of screening is indeed very high, many hospitals do not have rapid screening facilities. technology. Direct decolonization or direct isolation of high-risk groups may result in intervention for some uncolonized high-risk patients, but it may be more cost-effective than full screening.
