Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: Cluster Randomised Trial

DesignCluster randomised crossover trial with seven wards randomly allocated to intervention or control arm.SettingMedical and surgical wards of a university hospital with active MRSA control programme.ParticipantsAll patients hospitalized >48 h in study wards and screened for MRSA on admission and discharge Intervention: Rapid PCR-based screening test for MRSA compared with control screening test by enrichment culture using chromogenic agar.ObjectiveWe determined the benefit of PCR-detection versus culture-based detection of MRSA colonisation upon patient admission on early implementation of isolation precautions and reduction of hospital transmission of MRSA.Main outcomeCumulative rate of MRSA hospital acquisition of in patients screened negative on admission.RandomizationThe sequential order of inclusion of study wards in each arm was randomised by assigning a number to each ward and using a computer generated list of random numbers.FindingsOf 3704 eligible patients, 67.8% were evaluable for the study. Compared with culture, PCR-screening reduced the median test reporting time from admission from 88 to 11 hours (pInterpretationUniversal PCR screening for MRSA on admission to medical and surgical wards in an endemic setting shortened the time to implement isolation precautions but did not reduce nosocomial acquisition of MRSA.Trial registrationclinicaltrials.gov NCT00846105