Mandatory MRSA screening for all
patients admitted to English hospitals is unethical and should be reconsidered,
says Dr Michael Millar in an editorial published on BMJ.com.
Testing all patients for MRSA
began in April 2009 but Dr Millar, a microbiologist from Barts and The London
NHS Trust, questions the validity of consent for screening when the levels of
risk is not adequately explained to patients.
He says that consent is not
genuine as patients are not told that mandatory screening results in high
numbers of false positives, patients being placed in isolation and delays in
treatment. He argues 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 says 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 emphasise selective screening, and to US guidelines, which do not support
legislation to mandate MRSA screening".
While MRSA rates have fallen by
more than half from 2003 to 2009, says Millar, the overall number of healthcare
associated infections have been rising substantially, which raises questions
about the focus on MRSA, he says.
Dr Millar concludes that asymptomatic MRSA patients
present a low risk of transmission and the focus should be aimed at patients
with active infection and tackling poor staff hand hygiene. He says "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".