Original article Impact of rapid molecular screening for meticillin-resistant Staphylococcus aureus in surgical wards M. R. S. Keshtgar 1 , A. Khalili 1 , P. G. Coen 2 , C. Carder 2 , B. Macrae 2 , A. Jeanes 2 , P. Folan 2 , D. Baker 2 , M. Wren 2 and A. P. R. Wilson 2 1 Department of Surgery and 2 Department of Microbiology, Windeyer Institute of Medical Sciences, University College London Hospitals Foundation Trust, London, UK Correspondence to: Mr M. R. S. Keshtgar, Department of Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK (e-mail: m.keshtgar@ucl.ac.uk) Background: This study aimed to establish the feasibility and cost-effectiveness of rapid molecular screening for hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) in surgical patients within a teaching hospital. Methods: In 2006, nasal swabs were obtained before surgery from all patients undergoing elective and emergency procedures, and screened for MRSA using a rapid molecular technique. MRSA-positive patients were started on suppression therapy of mupirocin nasal ointment (2 per cent) and undiluted chlorhexidine gluconate bodywash. Results: A total of 18 810 samples were processed, of which 850 (4·5 per cent) were MRSA positive. In comparison to the annual mean for the preceding 6 years, MRSA bacteraemia fell by 38·5 per cent (P < 0·001), and MRSA wound isolates fell by 12·7 per cent (P = 0·031). The reduction in MRSA bacteraemia and wound infection was equivalent to a saving of 3·78 beds per year (£276 220), compared with the annual mean for the preceding 6 years. The cost of screening was £302 500, making a net loss of £26 280. Compared with 2005, however, there was a net saving of £545 486. Conclusion: Rapid MRSA screening of all surgical admissions resulted in a significant reduction in staphylococcal bacteraemia during the screening period, although a causal link cannot be established. Paper accepted 12 November 2007 Published online 27 November 2007 in Wiley InterScience (www.bjs.co.uk). DOI: 10.1002/bjs.6013 Introduction The incidence of hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) infection is rising worldwide, over and above the increase in meticillin-sensitive S. aureus (MSSA) infection. In the UK, the incidence of MRSA septicaemia increased by 5·5 per cent between 2001 and 2003–2004 1 with a corresponding rise in MRSA-related deaths 2 . Indeed, the UK is reported to have one of the highest rates of MRSA infection in Europe 3 . MRSA-colonized patients may have acquired the bacterium from previous hospital and nursing home admission, but others are truly community acquired 3–5 . The identification of MRSA carriers on admission and use of topical suppression may reduce the rates of MRSA The Editors are satisfied that all authors have contributed significantly to this publication infection 6 . Previously, routine MRSA screening relied on culture techniques with a turnaround time of up to 3 days. Polymerase chain reaction (PCR) technology now enables results to be reported within hours, so topical suppression protocols can start immediately. The aim of the present study was to establish the feasibility and cost-effectiveness of rapid molecular screening for MRSA in surgical patients within a teaching hospital, and to monitor the effect of rapid screening and topical suppression therapy on the rate of MRSA wound infection and bacteraemia. Methods After obtaining ethics committee approval, all patients admitted in 2006 (January to December inclusive) to the University College London Hospitals (UCLH) Foundation Trust for critical care, routine or emergency Copyright  2007 British Journal of Surgery Society Ltd British Journal of Surgery 2008; 95: 381–386 Published by John Wiley & Sons Ltd