2012 年全国耐甲氧西林金黄色葡萄球菌（MRSA）入院筛查一周患病率普查。
The national one week prevalence audit of universal meticillin-resistant Staphylococcus aureus (MRSA) admission screening 2012.
机构信息
University College London, London, United Kingdom.
出版信息
PLoS One. 2013 Sep 12;8(9):e74219. doi: 10.1371/journal.pone.0074219. eCollection 2013.
INTRODUCTION
The English Department of Health introduced universal MRSA screening of admissions to English hospitals in 2010. It commissioned a national audit to review implementation, impact on patient management, admission prevalence and extra yield of MRSA identified compared to "high-risk" specialty or "checklist-activated" screening (CLAS) of patients with MRSA risk factors.
METHODS
National audit May 2011. Questionnaires to infection control teams in all English NHS acute trusts, requesting number patients admitted and screened, new or previously known MRSA; MRSA point prevalence; screening and isolation policies; individual risk factors and patient management for all new MRSA patients and random sample of negatives.
RESULTS
144/167 (86.2%) trusts responded. Individual patient data for 760 new MRSA patients and 951 negatives. 61% of emergency admissions (median 67.3%), 81% (median 59.4%) electives and 47% (median 41.4%) day-cases were screened. MRSA admission prevalence: 1% (median 0.9%) emergencies, 0.6% (median 0.4%) electives, 0.4% (median 0%) day-cases. Approximately 50% all MRSA identified was new. Inpatient MRSA point prevalence: 3.3% (median 2.9%). 104 (77%) trusts pre-emptively isolated patients with previous MRSA, 63 (35%) pre-emptively isolated admissions to "high-risk" specialties; 7 (5%) used PCR routinely. Mean time to MRSA positive result: 2.87 days (±1.33); 37% (219/596) newly identified MRSA patients discharged before result available; 55% remainder (205/376) isolated post-result. In an average trust, CLAS would reduce screening by 50%, identifying 81% of all MRSA. "High risk" specialty screening would reduce screening by 89%, identifying 9% of MRSA.
CONCLUSIONS
Implementation of universal screening was poor. Admission prevalence (new cases) was low. CLAS reduced screening effort for minor decreases in identification, but implementation may prove difficult. Cost effectiveness of this and other policies, awaits evaluation by transmission dynamic economic modelling, using data from this audit. Until then trusts should seek to improve implementation of current policy and use of isolation facilities.
简介
2010 年，英国卫生部（Health）推出了对英国所有医院住院患者进行普遍耐甲氧西林金黄色葡萄球菌（MRSA）筛查。该部委托开展了一项全国性审计，以审查实施情况、对患者管理的影响、入院流行率以及与“高危”专科或“检查表激活”筛查（CLAS）相比发现的耐甲氧西林金黄色葡萄球菌（MRSA）的额外检出率。
方法
2011 年 5 月进行全国性审计。向英国国民保健署（NHS）所有急症信托机构的感染控制团队发放问卷，要求提供住院和筛查患者人数、新确诊或既往确诊的耐甲氧西林金黄色葡萄球菌（MRSA）患者人数；耐甲氧西林金黄色葡萄球菌（MRSA）现患率；筛查和隔离政策；所有新确诊耐甲氧西林金黄色葡萄球菌（MRSA）患者和随机抽样的阴性患者的个体危险因素和患者管理情况。
结果
167 家信托机构中有 144 家（86.2%）作出回应。共获得 760 例新确诊耐甲氧西林金黄色葡萄球菌（MRSA）患者和 951 例阴性患者的个体患者数据。61%（中位数 67.3%）为急症入院，81%（中位数 59.4%）为择期入院，47%（中位数 41.4%）为日间手术。耐甲氧西林金黄色葡萄球菌（MRSA）入院流行率：急症为 1%（中位数 0.9%），择期为 0.6%（中位数 0.4%），日间手术为 0.4%（中位数 0%）。大约 50%的耐甲氧西林金黄色葡萄球菌（MRSA）是新检出的。住院患者耐甲氧西林金黄色葡萄球菌（MRSA）现患率：3.3%（中位数 2.9%）。104 家（77%）信托机构对既往耐甲氧西林金黄色葡萄球菌（MRSA）患者进行了前瞻性隔离，63 家（35%）对“高危”专科的入院患者进行了前瞻性隔离；7 家（5%）常规使用聚合酶链反应（PCR）。耐甲氧西林金黄色葡萄球菌（MRSA）阳性结果的平均时间：2.87 天（±1.33）；596 例新确诊耐甲氧西林金黄色葡萄球菌（MRSA）患者中有 37%（219 例）在结果可用之前出院；其余 55%（205/376）在结果出来后进行了隔离。在平均每家信托机构中，CLAS 将减少 50%的筛查，检出 81%的耐甲氧西林金黄色葡萄球菌（MRSA）。“高危”专科筛查将减少 89%的筛查，检出 9%的耐甲氧西林金黄色葡萄球菌（MRSA）。
结论
普遍筛查的实施情况不佳。入院流行率（新发病例）较低。CLAS 减少了筛查工作量，但对检出率的影响较小，但实施可能很困难。这项政策和其他政策的成本效益，有待使用本次审计的数据通过传染病传播动态经济建模进行评估。在此之前，信托机构应寻求改进现行政策的实施情况，并充分利用隔离设施。
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