An editorial published on bmj.com today reports that mandatory MRSA screening for all patients admitted to English hospitals is unethical and should be reconsidered.
Since April 2009, all patients are tested for MRSA. Dr Millar, a microbiologist from Barts and The London NHS Trust, questions the validity of consent for screening when the levels of risk are not sufficiently explained to patients.
He argues that consent is not genuine. Patients are not told that mandatory screening results in high numbers of false positives. In consequence, patients are being placed in isolation and this causes delays in treatment. He explains that “patients placed in isolation can suffer psychological and physical harms, partly as a result of the reduced contact with healthcare workers and others.”
The author comments that there is little evidence that screening all patients for MRSA reduces infection rates and that this policy “runs contrary to current UK guidelines for the control of MRSA, which emphasize selective screening, and to US guidelines, which do not support legislation to mandate MRSA screening.”
Millar notes that from 2003 to 2009, MRSA rates have dropped by more than half. But the overall number of healthcare associated infections has been increasing considerably. This raises questions about the focus on MRSA, he remarks.
In closing, Dr Millar says that asymptomatic MRSA patients present a low risk of transmission. The focus should be designed for patients with active infection. It is also essential to tackle the problem of poor staff hand hygiene. He writes “it is generally agreed that MRSA is spread in hospitals on the hands of healthcare staff and that the determinants of transmission include microbial load and degree of contact with healthcare workers.”
“Should we screen low risk patients for meticillin resistant Staphylococcus aureus?”
Michael Millar, consultant microbiologist
BMJ 2009; 339:b4035
doi=10.1136/bmj.b4035
bmj.com
Written by Stephanie Brunner (B.A.)