Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infection at a teaching hospital

Abstract

A methicillin-resistant Staphylococcus aureus (MRSA) control policy, aimed at eradication, was established at a 1000-bed hospital in 1985, applied consistently for 10.5 years, and then relaxed. Its components included screening of high-risk patients, transfer of carriers to exhaust-ventilated isolation rooms, closure of wards to new admissions when local transmission was detected, MRSA screening during outbreaks, and prospective collection of clinical and epidemiological information. During the eradication policy period, every 6 months, a mean of 5.1 patients (range 1-12) already carrying MRSA were admitted, and a mean of 3.6 (range 0-16) acquired carriage in the hospital. The largest outbreak comprised 11 patients despite epidemic MRSA strain EMRSA-16 being introduced six times, and MRSA did not become endemic. MRSA-positive admissions increased progressively from 1993; nursing staff workload increased, areas available for alternative patient accommodation were reduced, the resulting ward closures interfered with clinical services, and hence the control policy was relaxed in mid-1995. Isolation facilities were overwhelmed with 622 new patient-isolates in the next 18 months, and there were 67 clinical infections in 1996. The proportion of blood cultures positive for MRSA rose nearly sevenfold by 1996 and 27-fold by 1997. Thus, repeated eradication of MRSA, even epidemic strains, by use of a stringent policy, is possible given sufficient resources, whereas flexible national guidelines designed to control, but not eradicate, epidemic staphylococci, are currently unlikely to be successful. The costs of eradication policies need to be weighed against those of endemicity.

Control of Nosocomial Methicillin-Resistant Staphylococcus aureus Where Shall We Send Our Hospital Director Next Time?

“…3 Is the "war" over? 4 Or, alternatively, should we not be considering increased efforts to control this persistent pathogen with screening policies and isolation precautions?…”

Are measures against MRSA transmission effective?

“…• arbeidet i eller vaert pasient i en helsetjeneste der det pågikk et MRSA-utbrudd 20 Med omfattende undersøkelse eller behandling menes:…”

“…I fire av disse studiene bidro kohortisolering eller isolering i enerom sammen med enkelte andre tiltak, til å kontrollere MRSA-utbrudd eller redusere forekomsten av MRSA på sykehus (14)(15)(16)(17)(18). I to av studiene bidro ikke egne isoleringsenheter til å hindre MRSA i å bli endemisk ved sykehusene (19,20).…”

Successful control of MRSA spread in the Netherlands

“…13 The number of people providing care not for citation purposes 15 Great Britain used to have a similar system, but deserted this protocol in 1995 because many hospitals did not have sufficient accommodation to comply with these measures. 16,17 Treatment of MRSA in the Netherlands is done in cooperation with infectious disease specialists. First choice treatment is currently vancomycin.…”