• SA = Staphylococcus Aureus
• MSSA = Meticillin-Sensitive Staphylococcus aureus
• MRSA = Meticillin-resistant Staphylococcus aureus
• GNB = Gram-negative bacilli
• MGNB = Multi-drug resistant Gram-negative bacilli; 
• includes GNB that are resistant to 3 classes of antimicrobials, e.g. piperacillin/tazobactam, gentamicin and ciprofloxacin, and GNB with specific resistance mechanisms such as ESBL, CARB, and CPE 
• ESBL = Extended Spectrum Beta-Lactamase-producing Gram-negative bacilli
• resistant to co-amoxiclav, piperacillin/tazobactam, and ceftriaxone
• may be resistant to other classes of antimicrobials such as aminoglycosides and quinolones
• but are sensitive to all carbapenems
• CARB = Carbapenem-resistant Gram-negative bacilli;
• these GNB may be more multi-drug resistant than ESBL
• may be fully resistant to carbapenems
• includes Multi-Drug Resistant Acinetobacter baumannii (MDRAB) that may be pan-resistant and CPE
• CPE = Carbapenemase-producing Enterobacteriaceae
• a subgroup of CARB
• include carbapenem-resistant Klebsiella pneumoniae, E. coli and Enterobacter cloacae;
• the 3 most common types of carbapenemase gene types in CPE are: OXA-48, KPC, and NDM

Responsible person

• Appoint someone to check results and inform consultant if MRSA/SA/MGNB/ESBL/CPE detected

Consent

• Explain reason for taking swabs and obtain patient’s consent

• To check if MGNB screening needed as well as MRSA or SA, check Transfer or emergency admission - screening for MRSA and/or MGNB below

Is the Patient due for any implant surgery, or any other SA infection high-risk procedure?

• Joint replacement
• Major cardiothoracic surgery
• Intra-cranial neurosurgery, including insertion of VP shunt
• Spinal surgery
• Vascular surgery with implants
• Breast implants in conjunction with reconstructive surgery
• Major reconstructive surgery
• Insertion of long-term dialysis lines
• Insertion of Hickman lines
• Insertion of feeding tubes into stomach and jejunum (PEGs and PEJs)
• Insertion of permanent pacemakers
• Interventions to existing pacemakers or other existing implants without complete removal

Summary of screening for MRSA and MSSA (that is both MRSA and Meticillin-Sensitive Staphylococcus Aureus), before elective admission or SA infection high-risk procedure in area for overnight stay, except maternity

Summary of screening for MRSA and/or MGNB on transfer or emergency admission

Elective STAPH screen

Timing

• NB: If undergoing MRSA decolonisation or other antimicrobial treatment, delay screening until >48 hr after completion
• If patient at home, screen 2-4 weeks (maximum 8 weeks) before SA infection high-risk surgery
• If patient not at home and not in hospital, screen 7 days (6-8 days) before transfer/procedure and again on admission
• If patient in hospital, send samples for STAPH SCREEN 7 days before elective SA high-risk surgery

How

• Swab anterior nares, perineum, throat, and any skin lesion or ulcer
• if long-term catheterised, add CSU
• if productive cough, add sputum
• Tick STAPH SCREEN on microbiology request card Procedure

Elective MRSA screen

Timing

• If patient at home, screen 2-4 weeks (maximum 6 months) before elective admission
• Negative MRSA screen remains valid for 6 months except if:
  
  • admission to a 'MRSA screen negative patient only' area/ward
  • requires S. aureus infection high risk surgery for which a negative MRSA screen
  • remains valid for 56 days (8 weeks) only
  • overnight stay in any health care facility between date of screening and the date of admission for planned SA infection high risk surgery
• If patient not at home and not in hospital, screen 7 days before transfer (include perineum swab) and again on admission
• If undergoing MRSA decolonisation or other antimicrobial treatment, delay screening until >48 hr after completion

How

• Swab anterior nares
• Swab any skin lesion or ulcer
• if long-term catheterised, add CSU
• if productive cough, add sputum
• Add swab from perineum:
• if patient tagged for MRSA on iPortal, or
• if patient is to be admitted to ‘MRSA screened patient’ area
• Tick MRSA SCREEN on request card Procedure

Screening for MRSA carriage on transfer or emergency admission

Timing

• NB: If undergoing MRSA decolonisation or other antimicrobial treatment, delay screening until >48 hr after completion
• Otherwise, immediate screen

How

• Swab anterior nares and perineum (swab from throat instead of perineum acceptable if consent for perineum swab cannot be obtained in acute admission area)
• Swab all ulcers and skin lesions
• if long-term catheterised, add CSU
• swab any IV line that is impractical to change and record VIP score 8-hrly
• if productive cough, add sputum
• Tick MRSA SCREEN on microbiology request
• if renal dialysis line in situ, request STAPH SCREEN instead

Screening for MGNB (includes screening for ESBL and CARB/CPE)

Timing

• Immediate

How

• Rectal swab
• If stoma, unable to obtain rectal swab, or the previous rectal swab screening result reported as 'INVALID', send 'faeces swab' from stool sample
• Ensure that swab has visible faecal material
• If long-term catheterised, add CSU 
• Tick MGNB SCREEN on microbiology request
• If a patient has been identified as a close contact of a patient with confirmed CPE by IP team, contact microbiology
  • submit the Copan rectal/stool swab, with visible faecal material, requesting 'CPE PCR test'