12:35am Monday 23 September 2019

Hospitals Should Stop MRSA Screening of Inpatients Due to Lack of Effectiveness

Screening patients in intensive care units for methicillin-resistant Staphylococcus aureus (MRSA) may lack effectiveness and should prompt hospitals to stop MRSA screening in these cases, according to an editorial by two Virginia Commonwealth University physicians published online this week in the New England Journal of Medicine. 

In the editorial, Michael B. Edmond, M.D., the Richard P. Wenzel Professor of Internal Medicine in theDivision of Infectious Diseases at the VCU School of Medicine and hospital epidemiologist at the VCU Medical Center, and Richard P. Wenzel, M.D., professor in theDepartment of Internal Medicine, discuss important new results of a large, multicenter study that formally assesses horizontal versus vertical strategies to prevent the spread of infection. That study, led by researchers from University of California, Irvine, was published in the same issue of the journal. 

According to Edmond, most hospitals use vertical infection prevention strategies, which focus on culturing for patients harboring organisms such as MRSA and isolating those patients. This can put patients at risk for problems that occur when the patient is isolated. A horizontal infection prevention strategy may include high compliance with hand washing and bathing of patients with chlorhexidine, an antiseptic soap. Both hand hygiene and chlorhexidine prevent not just MRSA but all infections that are transmitted via contact. 

In the study, 43 hospitals were randomly assigned to one of three intervention groups for all patients in adult intensive care units (ICUs). The first was mostly a vertical intervention, the second was a mix between vertical and horizontal and the third was mostly a horizontal strategy. The team found that active detection and isolation without decolonization was not effective in reducing rates of MRSA-positive cultures, MRSA bloodstream infections or bloodstream infections from any pathogens. 

“The study by Dr. Susan Huang and colleagues from the University of California is very important because it clearly demonstrates that screening patients for MRSA is an ineffective infection control strategy,” said Edmond. 

“This will result in fewer patients being placed in isolation, a practice that is difficult for patients and interferes with their care,” he said. 

Edmond and Wenzel wrote, “This study has implications beyond MRSA. New resistance mechanisms continue to emerge in nosocomial pathogens … Hopefully, the results of this study will redirect that discussion and reinforce the utility of horizontal interventions to control not only the pathogens of today but those of tomorrow as well.” 

Last year, Edmond presented findings at IDWeek 2012 of a VCU pilot study that employed a horizontal infection prevention strategy of high compliance with hand washing that prevents not just MRSA but all infections that are transmitted via contact. They demonstrated that high compliance with hand hygiene and focusing on other simple infection control measures on medical, surgical and neuroscience intensive care units resulted in reduced rates of MRSA-infection by 95 percent in a nine-year study.

EDITOR’S NOTE: A copy of the editorial is available to reporters in PDF format by email request from mediasupport@nejm.org.

Sathya Achia Abraham
University Public Affairs

Frances Dumenci
University Public Affairs

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