Methicillin-resistant Staphylococcus aureus: source control and surveillance organization

Methicillin-resistant Staphylococcus aureus (MRSA) has been a common nosocomial pathogen since the 1960s, and has become a major problem in hospitals worldwide. Patients and the public are increasingly seeing MRSA and rates of MRSA infections as indicators of the quality of patient care. The control measures aimed at reducing the spread of MRSA among hospitals and communities include the following: education of healthcare workers, with implementation and adherence to hand-washing practices; restriction of antibiotic use; active surveillance cultures (ASCs); contact isolation of MRSA-positive patients; and pre-emptive isolation of high-risk patients. However, despite these interventions, MRSA is still endemic in many hospitals worldwide. In particular, the role of ASCs is still under debate. International guidelines suggest that extensive ASCs should only be used in intensive-care units (ICUs), and routine screening of all hospital admissions is not usually advocated. Local decisions can be made on the basis of types of risk factor of non-ICU patients. Before starting ASCs, laboratories should be prepared for the workload, and the turn-around time for screening tests should be reduced and arrangements made to monitor the effectiveness of this intervention. Most recently, rapid methods for molecular detection of MRSA colonization have been developed. Published studies differ in their settings (ICU, medical wards, surgical wards), choice of patient population, severity of illness, hospital infection control measures, and study design. The existing evidence does not support the wide application of rapid molecular screening for MRSA.