Scotland is considering screening patients for methicillin resistant Staphylococcus aureus (MRSA) when they are admitted to hospital, to help reduce the incidence of healthcare associated infections.
The move comes after the completion of a comprehensive study of the prevalence of such infections in Scotland, which found that 9.5% of patients contract an infection while in Scottish hospitals. The annual cost is calculated to be £183m (€270m; $370m).
The study, carried out by Health Protection Scotland, was based on a survey of almost 14 000 patients—the entire acute hospital population at the time of the survey visits. The highest prevalence of healthcare associated infections was found in geriatric wards (12%), followed by surgery (11.2%), medicine (9.6%), and orthopaedics (9.2%). Obstetrics had the lowest rate (0.9%). The most common infections were urinary tract (18%), surgical (16%), and gastrointestinal (15.4%) infections.
Previous prevalence studies have found a prevalence of healthcare associated infections of 8.2% in England, 6.3% in Wales. 5.4% in Northern Ireland, 5.1% in Norway, 4.9% in the Republic of Ireland, and 3.6% in Germany. However, it is difficult to make accurate comparisons with the Scottish data because of differences in the study methods.
What is clear is that Scotland is making little progress in reducing the problem. The study report says that the number of cases of healthcare associated infection has not been significantly reduced, despite enormous efforts to improve infection control.
It adds: “A specific focus on areas of high risk, volume and cost is required in order to improve the quality of care and reduce the incidence of these HAIs [healthcare associated infections].”
The report says that what is needed is greater attention to the care and maintenance of devices such as catheters and mechanical ventilation, prevention of infections at sites of surgery, and prudent prescribing of antimicrobials.
Scotland has established an HAI Task Force, which will now examine the case for introducing an MRSA screening programme. A programme is already in force at the Golden Jubilee Hospital outside Glasgow, which has not had a single case of MRSA infection in the past two years. The hospital, which was bought from the private sector, also has single rooms, making it easier than in older hospitals with large communal wards to isolate patients.
Hugh Pennington, emeritus professor of bacteriology at the University of Aberdeen, said that such an approach nationally will need more investment. “At the end of the day, if we are going to solve this problem, we are going to have to think very seriously about having much more isolation, and that means spending a lot more money,” he said.
The prevalence survey has established the extent of the problem in Scotland. Further surveys will be carried out to evaluate trends and measure progress.
NHS Scotland National HAI Prevalence Survey: Final Report is available at www.hps.scot.nhs.uk.