Preventing infections from cannulas reduces MRSA

We have shown through bacteraemia surveillance (June 2003-December 2006) that 19 of 118 episodes (16.1%) of bacteraemia due to hospital acquired MRSA on medical and surgical wards were secondary to infected insertion sites of peripheral cannulas. In June 2007, King George Hospital, Barking, Havering and Redbridge Trust implemented a programme aimed to reduce these infections. This followed guidance in the “Saving Lives” programme.¹ Skin decontamination devices (Chlorprep Single Swab Applicator) and venflon packs were supplied to all wards. Labels for date of insertion and removal for peripheral cannulas were provided together with Tegaderm to replace tape and gauze dressings. Junior doctors and nurses were trained to use these packs and, in particular, how to label and insert cannulas in an aseptic manner.

From June 2007 to March 2008, total episodes of MRSA bacteraemia trustwide fell from 56 to 32 (42.9%) compared with the preceding 10 months. Over this 20 month period, policies on the selective screening of high risk patients (critical care, neonates, elective orthopaedic surgery, frequent hospital reattenders, and patients from care homes) remained unchanged. Recently, we screened all patients on six medical and surgical wards and showed that MRSA is as prevalent in our trust (median prevalence rate 11.5%, range 7-23%), as St Thomas’s (median value 6.1%, range 2.7-19.7%).

Based on Jeyaratnam et al’s finding² and our own experience locally, we believe the government target of universal MRSA screening of elective inpatients, costing our trust £97 000/year, is unlikely to affect MRSA bacteraemia rates. By March 2011, the government aims to screen all hospital inpatients for MRSA, which would cost an additional £837 000/year. This amount would be five times more expensive if polymerase chain reaction assays were introduced. In contrast, enhanced bacteraemia surveillance and targeted interventions aimed at reducing infection at sites that cause MRSA bacteraemia is likely to be money well invested. Universal screening seems to be wasteful, and we believe the government’s strategy to reduce MRSA infections through universal screening requires a fundamental rethink.