Protocol for CRA MRSA Screening National Rollout in Scotland

Admission screening by clinical risk assessment (CRA) allows for the early identification of patients who are colonised or are at high risk of being colonised, and allows them to be pre-emptively managed with the appropriate infection prevention and control precautions while swab results are awaited. There are two mandatory national screening policies in Scotland for MRSA and CPE (carbapenemase-producing Enterobacteriaceae).

This protocol was developed using intelligence from extensive research studies into the effectiveness of nasal swabbing as a screening test, and the use of screening questions (a Clinical Risk Assessment, CRA) as a first line screening test in relation to effectiveness as well as resource implications. The savings in resources compared with universal nasal swab-based screening also allow an enhanced programme for those patients for whom MRSA infection carries a particularly severe clinical impact – intensive care, orthopaedics, renal medicine and cardiothoracic/vascular surgery (please note this encompasses cardiothoracic, vascular and cardiovascular).

This protocol supersedes all previous versions of the national MRSA screening protocol, and represents a minimum level of screening which the Scottish Government Health and Social Care Directorate (SGHSCD) expects NHS Boards to undertake.