Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the Joint SHEA and APIC Task Force

Abstract

Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology, Inc., (APIC) have developed this joint position statement. Both organizations are dedicated to combating health care-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, the APIC and the SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) The SHEA and the APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) The APIC and the SHEA welcome efforts by health care consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and health care-associated infections. (4) The SHEA and the APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) The APIC and the SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.

Targeted Versus Universal Decolonization to Prevent ICU Infection

“…3,26,27 Our study included a direct comparison with highcompliance active surveillance and accompanying contact precautions, which have been associated with decreased rates of MRSA transmission and MRSA bloodstream infection. 9,16,25,27,28 Hospitals that have not fully implemented a strategy of screening and isolation may derive additional benefit from this intervention. Second, universal decolonization was implemented as part of routine practice with the use of the usual infrastructure of the hospital for practice change, without the need for on-site study personnel.…”

Colonización por Staphylococcus aureus resistente a la meticilina en una unidad de cuidados intensivos de adultos de un hospital colombiano: caracterización fenotípica y molecular con detección de un clon de circulación en la comunidad

“…En diferentes trabajos de investigación se ha determinado la prevalencia y la incidencia de colonización por SARM, principalmente en hospitales, en algunos de ellos se evalúa la efectividad de la tamización para prevenir la infección por este microorganismo (27)(28)(29); sin embargo, son pocas las publicaciones latinoamericanas al respecto y, en particular, en las unidades colombianas de cuidados intensivos de adultos (30).…”

Current Knowledge of Methicillin-Resistant Staphylococcus Aureus and Community-Associated Methicillin-Resistant Staphylococcus Aureus

“…For decontamination and a signifi cant decrease of the MRSA strains occurrence on the working surfaces in nurses' rooms the authors recommend using rags impregnated with 80% ethyl alcohol 161 . Each country follows its own recommendations 121,162,163 , which in most cases ensue from the amended recommendations of CDC in Atlanta 119 . In the Czech Republic, in connection with the increase in MRSA strain prevalence in hospitals a recommendation has been drafted by a group of prominent experts.…”