INF ECT ION CONT ROL
POC testing of trauma patients for MRSA
At Torbay Hospital in Torquay, the microbiology and orthopaedic departments collaborated to implement point-of-care testing (POCT) for methicillin-resistant Staphylococcus aureus to decrease turnaround times and increase bed occupancy, enhancing both the patient experience and efficiency, with significant cost benefits for the Trust.
Infection control is critical in all aspects of healthcare, and fast methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) testing at the point of patient care plays a key role, enabling hospitals to admit screened patients to the correct ward without delay.
This not only ensures that they receive the most appropriate treatment promptly, but also helps to avoid breaches of the four-hour accident and emergency (A&E) department target, improving the patient flow through the hospital. Torbay Hospital is the main hospital in South Devon and is managed by the Torbay and South Devon NHS Foundation Trust. Its orthopaedic department includes a 26-bed trauma ward and a 19-bed elective surgery ward. All elective beds are ring-fenced, meaning that patients are only admitted following a negative MRSA screen, to minimise the risk and potentially devastating consequences of infection following surgery. Typically, MRSA screening is performed in the laboratory using a culture-based technique, with turnaround times of up to 48 hours. However, with on-demand molecular testing already in use in the laboratory for other disease states, and successfully implemented for influenza and respiratory syncytial virus (RSV) testing in A&E, the orthopaedic and microbiology departments collaborated to introduce fast point-of- care testing (POCT) for MRSA on patients admitted via the emergency department, or on the trauma ward. This has reduced turnaround times to an hour, allowing the safe use of elective orthopaedic beds for appropriate trauma patients, helping to avoid breaches of the ring-fence and subsequent cancellation of planned surgeries.
Typically, MRSA screening using a culture-based technique has a turnaround time of up to 48 hours.
Before introduction of POCT Creating sufficient bed capacity is a challenge for hospitals across the country. At Torbay Hospital, the orthopaedic trauma ward, which accepts patients from A&E, was nearly always at maximum capacity. As a result, the four-hour A&E admissions target was frequently missed due to a lack of beds, and the situation deteriorated even further during the winter influenza season. The elective ward, on the other hand, was running at 70% capacity. To relieve some of the winter pressures, the hospital explored the possibility of opening the unoccupied beds for appropriate trauma patients; however, the elective ward was ringfenced for patients who had tested negative for MRSA, which could take up to 48 hours using culture-based methods. The problem was compounded when patients arrived at the hospital outside laboratory open hours, as swabs were not processed until the next day. If an MRSA result was not available, the patient might have an extended stay in A&E or be
48 l
WWW.CLINICALSERVICESJOURNAL.COM
admitted as an outlier to a surgical ward, having a negative impact on the four-hour admission target and patient experience. The alternative was for patients to be inappropriately admitted to the elective ward, which breached the ring-fence and resulted in the cancellation of planned surgeries, distressing patients and having severe financial repercussions for the Trust. It was a lose-lose situation that clearly needed to be resolved.
Cost of breaching the ring-fence Breaches of the ring-fence were most likely to occur overnight and at weekends when the pressure on beds was greatest. If, for example, a patient was transferred directly from A&E without MRSA screening, this would result in a breach of the ring-fence and surgery being cancelled. The ward would be deepcleaned, and surgery would not resume until everyone on the ward was confirmed to be MRSA-negative, with the loss of a day or more of theatre time. Patients who may have waited many
DECEMBER 2021
©CDC/Melissa Dankel; James Gathany
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
