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Patient Information

Pre-Operative Assessment Screening

MRSA Screening

Methicillin-resistant Staphylococcus aureus (MRSA) screening is required for all elective inpatient admission and any day case admission that will have metalwork inserted or removed.

Why do I need MRSA screen?

MRSA is a type of bacteria that is resistant to several antibiotics and are known to cause severe blood stream infections and surgical site infections. People are at higher risk for MRSA infection when they have surgery or have medical devices inserted in their body. The swabs that would be required include a minimum of two sites from the following: nose, perineum, device entry sites, wounds, urine, and sputum or any appropriate sites depending on clinical presentation. MRSA acquisition (colonisation and infection) other than bacteraemia can easily go undetected, hence the need to screen before planned surgery.

Can I get treatment if I am colonised with MRSA?

If you are colonised with MRSA, we will provide you with decolonisation treatment directly or work with your GP to start you on the treatment.

Decolonisation treatment may be given either in hospital or at home. It will usually include treatment with antiseptic bodywash/shampoo and nasal cream. A few days of treatment will usually get rid of the MRSA and is usually enough so that you can undergo surgery safely.
You will be provided with your screening result as soon as it is available.
Patients who are identified as MRSA positive will be provided with consistent and appropriate information. An MRSA patient information leaflet will also be provided. 

CPE Screening

The gut of every normal, healthy human contains bacteria called Enterobacterales. While they are in the gut, they cause no harm and help us digest our food. This is called colonisation. However, if these bacteria get into the wrong place, such as the bladder or bloodstream, they can cause infection. Carbapenemase-producing Enterobacterales (CPE) have developed a resistance to a powerful group of antibiotics called carbapenems. Carbapenems are an important group of antibiotics that doctors often rely on to fight infections where treatment with other antibiotics has failed. It’s important that we stop the spread of CPE in our hospitals. This will make sure that these antibiotics continue to be available to treat infections in the future.

If I have CPE, will I need treatment?

No, not normally. Patients who have CPE do not need to be treated as these bacteria live harmlessly in the gut, without causing problems. However, if you have an infection caused by CPE, you will need antibiotics to treat it.

Why are patients screened for CPE?

By knowing which patients are carrying CPE, we can make sure that they receive the best care to prevent the spread of CPE and to prevent infections. Infections caused by CPE can be difficult to treat. It is very important to know that someone is carrying CPE so that if an infection develops, medical staff can quickly identify the best antibiotic to treat it.

How are patients screened for CPE?

Patients who are admitted to acute hospitals in the UK are assessed at the time of admission to decide if they are at risk of carrying CPE. 
You may be asked to be screened for CPE if in the last 12 months you have:

  • been an inpatient in any hospital in the UK or abroad (including receiving holiday dialysis),
  • had multiple hospital treatments (dialysis dependent and cancer chemotherapy),
  • been identified as contact of a known carrier of CPE, or has had recent exposures to antibiotics (cephalosporins, piperacillin/tazobactam, fluoroquinolones and carbapenems) in the last 3 months.

How will I be tested for CPE?

If you need a sample to be taken for testing, a nurse will insert a swab a small distance into your rectum (bottom). Or they may test a sample of faeces (poo). Some other samples may be needed, for example if you have a wound or urinary catheter.

Your privacy and dignity will always be respected when these samples are being taken.

Should you choose to have this screen done by yourself, a nurse will be available to guide you and receive the swab stick from you.

All swabs and samples will be sent to the laboratory to see which bacteria grow, and your clinical team will tell you the results.

You may be asked to stay in a single room until the result of your test is known.

Further information

If you have further questions, please discuss with a member of the department team. You can also ask to speak with a member of the Infection Prevention and Control Team.

The Royal Orthopaedic Hospital | T: 0121 685 4000 |