Figure 1: Workflow Staphylococcus screening in ER care, POCT – point-of-care...
Figure 1: Workflow Staphylococcus screening in ER care, POCT – point-of-care test, MSSA – methillin-sensitive Staphylococcus aureus, MRSA – methillin-resistant Staphylococcus aureus

Combatting nosocomial infections

A&E Staphylococci POCT

Martin Möckel and Dorothee Riedlinger, from the Charité Medical University Berlin, Emergency and Acute Medicine Campus Virchow-Klinikum, and Campus Charité-Mitte report on POCT testing in the A&E Department to screen for Staphylococcus aureus colonisation of the nose or throat.

Report: Walter Depner

People colonised with Staphylococci are at increased risk of developing a nosocomial, i.e. hospital acquired infection (HAI), the origin of which will be endogenous – i.e. the patient’s own disease reservoir. Colonisation with staphylococci is common: 20-30% of the healthy population is colonised by Methicillin-sensitive Staphylococcus aureus (MSSA), 2-3% are colonised by Methicillin-resistant Staphylococcus aureus (MRSA).

portrait of martin möckel
Martin Möckel MD is a Senior Physician, Professor of Cardiology and Head of Emergency Medicine and Acute Cardiovascular Care at Charité, University Medicine Berlin

Figures on the prevalence of nosocomial infections are based on estimates. An annual 2.6 million nosocomial infections are estimated to occur within the EU, with 400,000 - 600,000 of those arising in Germany. The presence of nosocomial infections leads to extended hospital stays and treatment in intensive care, as well as to around 90,000 deaths a year across Europe.

Patients suffering from acute illness are admitted to the hospital via A&E departments. The prevalence of Staphylococcus colonisation amongst those admitted via A&E is not known upon admission. However, along with acute treatment, preventive treatment, which would improve overall healthcare, can be offered in the A&E department as well. Based on this hypothesis, it was examined whether a POCT hospital admission screening system for nasopharyngeal colonisation by Staphylococcus aureus in A&E is feasible.

102 cases were examined

portrait of dorothee riedlinger
Dorothee Riedlinger is Scientific Assitant in the Emergency and Acute Medicine Campus Virchow-Klinikum, and Campus Charité-Mitte Berlin

© Wiebke PeitzI/Charité

A&E nurses took nasopharyngeal swabs from all patients admitted to our large, inner city A&E department, irrespective of whether they were seen for out- or in-patient treatment. 102 consecutive, non-selective cases were examined using the POCT system. (The examinations were carried out using a prototype of the MSSA/MRSA-assay of the cobas LIAT system from Roche). 26.4% of these swabs tested positive for colonisation with MSSA; three swabs tested positive for MRSA. In only one case had MRSA colonisation been previously described. It was possible to integrate this screening into the A&E admission process without delay.

In the second step, nasopharyngeal swabs were taken from 1,000 consecutive patients and examined for the risk factors for MRSA colonisation, as detailed by the Robert-Koch-Institute. In this cohort, 30.4% of patients were colonised by MSSA and 2.7% were colonised by MRSA. Based on their anamnesis, only 26.1% and 59.3% respectively of those examined were at an increased risk of colonisation with MRSA, which would have called for routine screening.

Figure 2: Staphylococcus colonisation by body part
Figure 2: Staphylococcus colonisation by body part

Early screening exams with fast/easy test systems

These examinations show that the cohort of those admitted to A&E have a rate of Staphylococcus colonisation similar to that described above, which indicates that early screening examinations in the context of acute care provision with fast and easy test systems is possible.

As the existing factors for risk determination only capture a part of colonised patients, it makes sense to look at other criteria for screening examinations. One option is that certain illnesses and treatments which, in turn, have a higher risk of nosocomial infections – such as invasive mechanical ventilation, emergency surgery or severe infection – should automatically involve screening and specific follow-on procedures, such as decolonisation treatment. Further analysis is required to determine which patient collectives should benefit from early screening, and studies should confirm the benefit of preventive measures, such as decolonisation treatment to reduce nosocomial infections.

The objective is to reduce the prevalence of nosocomial infections through early, specific preventive measures.


Profiles:

Martin Möckel MD is a Senior Physician, Professor of Cardiology and Head of Emergency Medicine and Acute Cardiovascular Care at Charité, University Medicine Berlin, Germany. He is also an Adjunct Professor at James Cook University, School of Public Health and Epidemiology, Townsville, Australia. The professor’s research focuses on biomarkers, healthcare in emergency and acute medicine and the implementation of interventional therapy in acute coronary care. He has led a number of multicentre trials. Martin Möckel is also part of the biomarker core groups of the Acute Cardiovascular Care Association and the 2019 congress president of the German Society for Internal Intensive Care and Emergency Medicine.

Dorothee Riedlinger is Scientific Assitant in the Emergency and Acute Medicine Campus Virchow-Klinikum, and Campus Charité-Mitte Berlin, Germany.

19.09.2019

Read all latest stories

Related articles

Photo

MRSA

Decolonization protocol can prevent dangerous infections

Antiseptic soap, mouthwash, and nose ointment after hospital discharge reduced infections and infection-associated hospitalizations due to MRSA in high-risk patients. Hospital patients who have…

Photo

Emergency medicine

D-dimer POCT for DVT considered ‘game-changer’ in ambulatory care

Radiometer Limited’s AQT90 FLEX analysers have been used in a successful trial to asses D-dimer point-of-care testing (POCT) for suspected lower limb deep vein thrombosis (DVT). The editorial…

Photo

Inexpensive invention

Test kit enables quick and accurate screening of diseases

Test results are denoted by a colour change and could be further analysed by a smartphone app, making it attractive as a point-of-care diagnostic device.

Related products

Atlas Genetics - Atlas Genetics io system

Infectious diseases testing

Atlas Genetics - Atlas Genetics io system

Atlas Genetics Ltd
DiaSys Diagnostic Systems - InnovaStar

Clinical chemistry

DiaSys Diagnostic Systems - InnovaStar

DiaSys Diagnostic Systems GmbH
Exias Medical – e|1 Analyzer

Blood Gases, Electrolyte, Oximetry

Exias Medical – e|1 Analyzer

EXIAS MEDICAL GmbH
INPECO SA – PROTUBE

Other

INPECO SA – PROTUBE

Inpeco SA
i-Solutions Health – LabCentre

LIS, Middleware, POCT

i-Solutions Health – LabCentre

i-SOLUTIONS Health GmbH