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Review Article

SRP. 2016; 7(1): 1-9


A Systematic Review on Prevention of Methicillin-Resistant Staphylococcus aureus Infection by Pre-Admission Screening: The Cost Effectiveness and Practicality

Nurul Izzati Binti Abdul Halim, Nor Azlina Binti A. Rahman, Noraziah Binti Mohamad Zin, Mohd Shukri Bin Baba, Nor Iza A Rahman, Mainul Haque.

Abstract
Background: Methicillin Resistant Staphylococcus aureus (MRSA) is a
common source of nosocomial infection, which is spreading through the
community and hospitals across the countries. The performance of screening
program really needs major effort related to laboratory capacity and ethical
consideration, among other costly components. Significant literature research
was conducted to review the cost, effectiveness and practicality of different
methods of pre-admission MRSA screening in the hospital setting.
A systematic literature review was conducted with search strategy using the
PubMed Medline, Scopus and the Science Direct databases. The relevant
data was abstracted from all studies based on various countries which in
line with the finalized eligibility criteria. Results: PCR method was reported
to have high sensitivity with low turnaround time as compared to culture
method. A review of selected studies found the increasing annual costs
of screening from standard culture, chromogenic agar to rapid PCR. In the
meantime, other studies reported the total costs for labor and materials
was lower for rapid PCR screening compared to culture methods. The
culturing method offers a high level of variability due to time consumption
and additional costs. Whereas PCR was reported as advantageous in term
of saving time to identify MRSA positive patients, which involved isolation,
thus increase the effectiveness of screening programs. It can pick up false
negative results by conventional methods in the early condition of disease.
Conclusion: Most studies verified that PCR is the most accurate method
for detection of MRSA with Xpert MRSA having the best performance.
Otherwise, oxacillin agar screen was revealed as a good alternative method
to PCR. Targeted screening on high risk patients using rapid PCR may
be the best choice to be implemented, in order to balance the economic
and practicality of screening. We recommend that further clinical studies
should be done to provide a sharp evidence of MRSA screening.

Key words: Prevention, MRSA, Pre-Admission, Screening, Cost-Effectiveness.



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