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Universal Surveillance for MRSA — Does It Help?
Surveillance involving all admitted patients, and the infection-control measures thus triggered, significantly decreased MRSA infection rates during hospitalization and for 30 days after discharge.
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are on the rise, and pressure is increasing from governmental agencies and the public to implement programs to prevent hospital-associated MRSA (HA-MRSA) disease. Active surveillance for MRSA carriage in hospitalized patients has been recommended as one strategy, but the success and cost-effectiveness of this approach are controversial. Now, in a multiphase study, researchers in Illinois have examined the effect of expanded surveillance on the incidence of HA-MRSA infections in a three-hospital healthcare system with 40,000 annual admissions. Several of the researchers have ties to companies that make rapid MRSA detection tests.
During the baseline phase (12 months), routine surveillance for MRSA colonization did not occur. If clinical cultures indicated MRSA colonization, contact precautions were instituted, but decolonization was not attempted. During phase 2 (12 months), all patients admitted to ICUs were assessed for nasal MRSA carriage using PCR-based testing. Contact precautions were instituted for colonized patients, but decolonization was not standard policy. During phase 3 (21 months), all admitted patients were assessed for nasal MRSA carriage. For patients testing positive, isolation precautions were instituted, and decolonization with nasal mupirocin ointment and chlorhexidine cleansing was recommended. Hospital-wide rates of HA-MRSA bloodstream, respiratory, urinary tract, and surgical-site infections were measured during each phase.
During the baseline year, the MRSA infection rate was 8.9 per 10,000 patient-days. During phase 2, in which 75.9% of 4392 ICU patients were tested (8.3% positive), the infection rate was 7.4 per 10,000 patient-days (a nonsignificant change). However, during phase 3, in which 84.4% of all admitted patients were tested (6.3% positive) and decolonization was attempted in more than half of those determined to be carriers, the infection rate fell significantly, to 3.9 per 10,000 patient-days. This diminution in infections was maintained for 30 days after discharge but not thereafter.
Comment: Several other studies assessing the effects of surveillance and intervention on the incidence of HA-MRSA infection have shown no significant benefit (Journal Watch Infectious Diseases Mar 26 2008). Although an editorialist points out that the effects of isolation and decolonization are not addressed independently in this article, without universal surveillance, such infection-control efforts could not be targeted appropriately. HA-MRSA disease is an extremely important issue, and extensive effort should be directed toward determining elements of infection control that are both beneficial and cost-effective.
Published in Journal Watch Infectious Diseases March 26, 2008
Citation(s):
Robicsek A et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008 Mar 18; 148:409.
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- Medline abstract (Free)
Lautenbach E. Expanding the universe of methicillin-resistant Staphylococcus aureus prevention. Ann Intern Med 2008 Mar 18; 148:474.
- Original article (Subscription may be required)
- Medline abstract (Free)