The government's policy of screening patients for MRSA before they are admitted to hospital breaches ethical guidelines, a senior microbiologist argues today.
Screening has been rolled out since April across the NHS on the basis that it will help protect patients from the
The government's policy of screening patients for MRSA before they are admitted to hospital breaches ethical guidelines, a senior microbiologist argues today.
Screening has been rolled out since April across the NHS on the basis that it will help protect patients from the effects of the superbug they may be carrying on their skin, says Dr Michael Millar, who works at Barts and the London NHS trust, in an article published online today by the British Medical Journal.
But there is little evidence to prove they will be safeguarded from infection, he says, and there is a risk they may suffer harm.
National guidelines from the Health Protection Agency say that those known to be at risk from MRSA (drug-resistant staphylococcus aureus) or who could suffer seriously if infected should be screened. "The difficulty with this policy is that we are moving towards screening lots of people with very low risk of having a problem with MRSA and there isn't much evidence that they are going to benefit," says Millar.
Indeed, he says, they could even be harmed. Their routine hospital admission may be delayed while they are given creams and special body washes to eradicate the bacteria at home.
At the moment, screening is carried out only for routine admissions, but it will be extended next year to patients who arrive as emergency cases.
"If they come in as an emergency, they may be put into isolation," says Millar.
Isolation can have a damaging psychological effect on a patient and carries a higher risk of accidental injury because nursing staff are not always present. "They are more likely to fall out of bed or have a drug error made," he says. It has been estimated that such screening could increase fourfold the number of patients put in isolation.
Screening for MRSA is not highly accurate and some people will be wrongly identified as carriers of MRSA. Millar says patients are not effectively giving informed consent to screening, as they should be, because they are not being warned of the inaccuracy of screening and the possibility that they will be pinpointed as a carrier when they are not.
The patients at most risk are carriers who need surgery, because the bacteria can infect the wound. "Some patients may therefore benefit from eradication of MRSA before admission or surgery, although the extent of this benefit in patients without other risk factors for MRSA infection is uncertain," Millar writes in his paper.
Patients who have MRSA but no symptoms of infection present a low risk of transmission to others, he says, arguing that the focus should be on patients with active infection and on tackling poor staff hand hygiene. He says that "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".
While rates of MRSA infection have fallen by more than half from 2003 to 2009, says Millar, the overall number of healthcare-associated infections has been rising substantially, which raises questions about the focus on MRSA.
The Department of Health reiterated its belief that screening for MRSA protected patients.
"Although the chance of acquir