1. MRSA on Ward 29 University Hospital Aintree (UHA) April 2006-August 2010 Zoe Greenwood February 2011

2. Introduction Methicillin Resistant Staphylococcus Aureus (MRSA) is a significant cause of mortality and morbidity 1-5. It has been shown to increase length and cost of a patient’s hospital stay 1-5. There are regular scare stories and statistics in the public media about this ‘Superbug’ which causes undue anxiety and can mislead patients.

3. Background Aims -To identify MRSA cases on Ward 29 at UHA -To compare with results from previous study 2001- 2005*(see next slide) Study period -April 2006 – August 2010 There is a lack of research into MRSA in Maxillofacial surgery patients

4. Results from previous study S Rogers, K Proczek, R Sen, J Hughes, P Banks, D Lowe. Which patients are most at risk of methicillin resistant Staphylococcus aureus: a review of admissions to a regional maxillofacial ward between 2001 and 2005. BJOMS 46 (2008) 439-444. This study found the rate of MRSA to be 1.1% (115 episodes in 97 patients from 10109 admissions) It found that although the overall risk of MRSA was low, it was more prevalent in oncology patients. Risk factors for MRSA were identified, the following were the most statistically significant (oncology patients): -Stage of cancer -Presence of free flap

5. Data collection The information from microbiology included: Date of first positive Date of first positive Screen or swab Screen or swab Site positive Site positive Any further positive episodes Any further positive episodes This was a retrospective review of hospital databases. The Microbiology department identified MRSA cases and these could then be recorded alongside details including: Date of admission Date of admission Date of discharge Date of discharge Date of birth Date of birth Consultant Consultant Diagnosis Diagnosis Treatment/surgery if given and date Treatment/surgery if given and date

6. Results Ward 29 April 2006 - August 2010 Number of patients Total admissions 8505 Total transfers 8015 Total 16520 (including year 2006) 14041 (excluding year 2006) Total MRSA positive 73 patients, 89 episodes Total MFU patients 10735 (including year 2006) Total MFU with MRSA 64 MFU Oncology (current or previous) 55 MFU Other 9 Total W29 Outliers 9 Daycases or pre-op (MFU) 11

7. Results MRSA positive episodes on Ward 29 2007-Aug 2010 It has become apparent that there were no MRSA cases identified in 2006 – I am assuming for now that this is an error in criteria selection during data collection

8. Results Year MRSA cases Total patients % 20072036770.54 20082639060.67 20092938150.76 20101426480.53 This table shows that the MRSA rate appears to be relatively low. It compares favourably to recent studies which round MRSA acquisiton on surgical wards to be 2.2% 2 and 0.2-2.9% 4. The study by Mr S Rogers et al 2008 which demonstrated an MRSA rate of 1.1% 3

9. Discussion So far it seems this audit has shown that the rate of MRSA has decreased Potential reasons for decrease rate - use of side rooms (isolation) - use of side rooms (isolation) - improved cross infection control including introduction of alcohol gel at all ward/room entrances - improved cross infection control including introduction of alcohol gel at all ward/room entrances - Venflon and tracheostomy care plans - Venflon and tracheostomy care plans - Use of MRSA eradication policy pre admission if detected at pre-op screening. - Use of MRSA eradication policy pre admission if detected at pre-op screening. Potential reasons may expect increase in rate - increase in detecting MRSA with pre op screening - increase in detecting MRSA with pre op screening

10. Discussion continued UHA started MRSA screening for elective admissions in February 2009, ahead of the Department of Health’s target date. It is due to start screening all patients including emergency admissions in March 2011. How effective and efficient has this been? How effective and efficient has this been? How effective has the eradication been? How effective has the eradication been? A 9 year study in vascular surgery patients showed that MRSA screening identified patients at risk of post operative complications and hence after treatment they experienced a reduction in complications 6.

11. References 1. J Am Geriatr Soc. 2010 Mar;58(3):527-32. Epub 2010 Feb 11. Poor functional status is an independent predictor of surgical site infections due to methicillin-resistant Staphylococcus aureus in older adults. Chen TY, Anderson DJ, Chopra T, Choi Y, Schmaer KE, Kaye KS. 2. Clin Microbiol Infect. 2010 Apr;16(4):333-9. Epub 2009 Jul 20. Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study. Hardy K, Price C et al 3. Br J Oral Maxillofac Surg. 2008 Sep;46(6):439-44. Epub 2008 Jun 13. Which patients are most at risk of methicillin resistant Staphylococcus aureus: a review of admissions to a regional maxillofacial ward between 2001 and 2005. Rogers SN, Proczek K, Sen RA, Hughes J, Banks P, Lowe D. 4. J Bone Joint Surg Br. 2006 Jun;88(6):812-7. Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control. Nixon M, Jackson B et al

12. References continued 5. Br J Oral Maxillofac Surg. 2006 Jun;44(3):217-21. Epub 2005 Jul 27. Infection of surgical wounds in the maxillofacial region and free flap donor sites with methicillin-resistant Staphylococcus aureus. Avery CM, Ameerally P et al. 6. Int Angiol. 2006 Jun;25(2):204-8. The success of routine MRSA screening in vascular surgery: a nine year review. Malde DJ, Abidia A et al. 7.http://www.aintreehospitals.nhs.uk/Library/pdf_files/MRSASCreeningPolicy.p df