INF ECT ION CONT ROL
Prior to the introduction of POCT, the elective orthopaedic ward was operating at 70% bed capacity. Fast PCR testing allows the department to manage beds more efficiently, safely increasing occupancy so that hospital resources, such as surgeons and theatre slots, are used effectively.
months for surgery would be let down and forced to make new personal arrangements, and the hospital had to take action to avoid breaching the 52-week referral time to treat (RTT).
The financial implications were huge; breaches of the specified RTT potentially incur large fines, which can be hundreds of thousands of pounds a year. Faster turnaround times for MRSA testing were essential to enhance clinical efficiency and patient flow through the hospital, helping to avoid the additional financial burden or penalties, as well as improving the patient experience.
Turnaround time challenge Short turnaround times and an efficient patient flow through the hospital are crucial at all times, and even more important during the winter influenza season or in a pandemic situation such as the SARS- CoV-2 and COVID-19 disease crisis. The hospital had previously successfully implemented a two-channel GeneXpert system (Cepheid) in A&E for rapid POCT for influenza/RSV. This complemented the 16-channel system used in the hospital’s microbiology laboratory for influenza/RSV, norovirus, carbapenemase- producing Enterobacteriaceae (CPE), vancomycinresistant enterococci (VRE), human immunodeficiency virus (HIV), hepatitis C virus (HCV), Mycobacterium tuberculosis (MTB) and Chlamydia and gonorrhoea (CT/NG) confirmation. The logical next step was to explore the possibility of extending near-patient testing to include MRSA testing for trauma admissions.
This would allow rapid screening of patients arriving at A&E and the emergency admissions unit 24 hours a day, avoiding the long turnaround times inherent in culture- based testing. Individuals who tested MRSA- negative could then be admitted to the right ward first time, without breaching the ringfence, improving the patient experience and flow through the hospital.
Proving the point The orthopaedic department successfully piloted the GeneXpert system and Xpert MRSA NxG test (Cepheid) during January and February 2019, performing on-demand testing in parallel with the conventional culture method to validate the results. The trial quickly established molecular testing as an indispensable tool, delivering fast and accurate results to enable better – and safer – bed management for improved patient care. Results are available within an hour, and screening can take place outside laboratory open hours. Following this successful trial, a four channel system was installed on the trauma ward. Currently, the department is performing around 1000 tests a year, without the need for additional staff, supported by the microbiology laboratory. Appropriate patients arriving in A&E are screened using fast PCR testing, and MRSA-negative patients are then transferred directly to the elective ward for specialist care. This avoids an interim stay on a different ward and frees capacity in A&E. Prior to the introduction of POCT, the
elective orthopaedic ward was operating at GeneXpert system
70% bed capacity. Fast PCR testing allows the department to manage beds more efficiently, safely increasing occupancy so that hospital resources, such as surgeons and theatre slots, are used effectively. Trauma patients are now directed to the correct ward – with the right resources – first time, avoiding any delay in treatment that could extend the length of stay. Point-of-care testing for MRSA is now a
key part of the Trust’s winter plan, preventing orthopaedic patients from impeding the flow through the hospital, and ensuring maximum bed availability during the influenza season. In the past, breaches of the ring- fence were quite frequent, leading to the cancellation of elective surgeries while the ward was deep cleaned, and the patients were confirmed MRSA-negative. This was distressing for patients and demoralising for hospital staff, and impacted the agreed 52-week RTT, with an enormous knock-on effect financially.
Since the introduction of fast PCR testing, the ring-fence has not routinely been breached. This, in turn, has dramatically reduced the need to outsource surgical cases. The considerable overall cost-saving enabled the Trust to achieve a return on investment within one month.
Torbay Hospital has established molecular testing as an indispensable tool. DECEMBER 2021
In summary Fast molecular PCR testing has enabled Torbay Hospital to make the most effective use of its existing facilities, opening up additional beds to help achieve the A&E admission target, and virtually eliminating breaches of the MRSA ring-fence. Trauma patients benefit from fast screening on arrival and are directed to the elective ward for specialist care if MRSA-negative. This has had a positive impact across the hospital, maximising bed occupancy and minimising the cancellation of elective surgeries. It also speeds up the progression of patients along the care pathway, improving the patient experience, and has driven down the associated breaches of the 52-week RTT target.
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