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To screen or not to screen for methicillin-resistant Staphylococcus aureus

NorthShore University HealthSystem, Department of Laboratory Medicine and Pathology, 2650 Ridge Avenue, Walgreen Bldg., SB525, Evanston, IL 60201, USA.
Journal of clinical microbiology (Impact Factor: 4.23). 03/2010; 48(3):683-9. DOI: 10.1128/JCM.02516-09
Source: PubMed

ABSTRACT There are few more compelling questions in clinical microbiology today than the issue of whether or not to screen for the presence of methicillin-resistant Staphylococcus aureus (MRSA), with the results being used to institute infection control interventions aimed at preventing transmission of MRSA in health care environments. Numerous different matters must be addressed when considering a screening program. Who is to be screened, what method is to be employed to detect MRSA, and what sites should be sampled? When and how often should the screening be performed? Who is going to pay for the screening, and, finally and perhaps most importantly, how are screening results to be communicated to health care providers and what kind of interventions are best undertaken based on the results? Numerous governmental agencies have mandated MRSA screening programs, and yet several authorities in infection control organizations have questioned the appropriateness of mandated screening. In this Point-Counterpoint feature, Dr. Lance Peterson of Evanston Hospital (Evanston, IL) offers his perspective on why screening for MRSA is to be encouraged. Dr. Daniel Diekema of the University of Iowa Carver College of Medicine (Iowa City, IA) offers an opposing view.

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    • "Keywords infection prevention methicillin-resistant Staphylococcus aureus MRSA patient safety successfully in the Netherlands and other Scandinavian countries for over a decade (Verhoef et al., 1999; Vos et al., 2009), the effectiveness of this strategy for reducing MRSA infections in the United States is not without controversy (Peterson & Diekema, 2010). The effect of universal ASC at admission on MRSA infections has varied between studies (Harbarth et al., 2008; Huskins et al., 2011; Jain et al., 2011; Robicsek et al., 2008), and reductions in hospital-acquired infections have been observed in the absence of ASC (Edmond, Ober, & Bearman, 2008). "
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    ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals. To address this need, a multifaceted program for MRSA infection prevention was developed for implementation in 159 acute care facilities. This program featured five distinct tools-active MRSA surveillance of high-risk patients, enhanced barrier precautions, compulsive hand hygiene, disinfection and cleaning, and executive champions and patient empowerment-and was implemented during 1Q-2Q 2007. Postintervention (3Q 2007-2Q 2008), 10.2% of patients with high-risk for infection or complications due to MRSA had nasal colonization. Volume of disposable gown and alcohol-based hand sanitizer use increased substantially following program implementation. Self-reported rates, based on NHSN definitions, of healthcare-associated central line-associated bloodstream infections and ventilator-associated pneumonia due to MRSA decreased 39% (p < .001) and 54% (p < .001), respectively. Infection rates continued to decrease during the follow-up period (1Q-4Q 2009). This sustained improvement demonstrates that reducing healthcare-associated MRSA infections in a large number of diverse facilities is possible and that a "bundled" approach that translates science into clinical and executive performance expectations may aid in overcoming traditional barriers to implementation.
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    • "Peterson [25] summarised the results from recent publications illustrating the impact of different levels of sensitivity and TAT in reducing the number of MRSA infections and concluded that until the estimated captured isolation days exceed 80% there will be no impact on either transmission or infection rates over short periods of time. In the same article, Diekema [25] makes the salient point that other infection control interventions (rather than rapid testing) may be equally or even more effective in reducing the incidence of MRSA. Nevertheless, rapid MRSA screening may provide advantages over conventional methods, but these still need to be tailored to the specific setting and modalities and require further validation. "
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    ABSTRACT: Based on the failure of conventional control strategies, some experts and public health officials have promoted active screening to detect asymptomatic carriers of meticillin-resistant Staphylococcus aureus (MRSA) as an effective prevention strategy. Data regarding the (cost-) effectiveness of MRSA screening have recently grown and have produced mixed results. Several clinical studies have not only provided conflicting findings but have also raised numerous issues about the appropriate populations for universal versus targeted screening, screening method(s) and intervention(s). It must also be emphasised that screening alone is not effective. Results should be followed by appropriate interventions to reduce the risk of MRSA transmission and infection. We believe a reasonable approach in most European hospitals with an MRSA on-admission prevalence of <5% is to use targeted rather than universal screening (predominantly with chromogenic media, except for high-risk units and critically ill patients for whom molecular tests could be cost effective), after carefully considering the local MRSA epidemiology, infection control practices and vulnerability of the patient population. This strategy is likely to be cost effective if linked to prompt institution of control measures.
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