Meticillin (the recommended international non-proprietary name for methicillin) is an antibiotic that was developed from penicillin when bacteria developed resistance to it. Unfortunately some bacteria, notably Staphylococcus aureus, have since developed resistance to meticillin and related antibiotics too. Infections with Meticillin-resistant Staphylococcus aureus (MRSA) have become an important public health problem both in hospitals and in the community. The number of death certificates in England and Wales specifying MRSA increased from 51 in 1993 to 1,629 in 2005. The control of MRSA in hospital depends on identifying patients carrying the bacterium, treating them with nasal and skin disinfection and taking steps to prevent cross-infection. Surgical patients are at particular risk of MRSA infection because the bacterium needs a break in the skin to enter the body.

In January 2006 University College London Hospitals became the first UK NHS Trust to introduce a rapid polymerase chain reaction method to detect MRSA. Microbiology Department staff had previously published evidence that, compared with culture as the gold standard, the rapid test’s sensitivity and specificity were 95.0% and 98.8%. The impact of introducing the new test was reported from the Departments of Surgery and Microbiology online in the British Journal of Surgery on 27 November 2007.

Nasal swabs were obtained from all patients having elective or emergency surgery in 2006. Of the 18,810 samples, 850 (4.5%) were MRSA positive. Patients with positive swabs were treated with mupirocin nasal ointment and chlorhexidine gluconate bodywash before operation. Patients needing urgent surgery before their swab results were available were treated as though they were positive.

During 2006 there were 13% fewer wound infections and 39% fewer serious blood infections (staphylococcal septicaemia) than the mean values for 2000-2005. Careful attention to hand hygiene and treatment of MRSA carriers were in place well before the study started, so the authors suggest that the reduction in infections may be because the reduced turnaround time allowed earlier treatment. Their cost analysis showed that, although the rapid screening program was expensive, the reduction in infections produced almost equal savings.