Editorials

Screening for MRSA

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39535.650336.BE (Published 24 April 2008) Cite this as: BMJ 2008;336:899
  1. Mark H Wilcox, professor of medical microbiology
  1. 1Leeds Teaching Hospitals and University of Leeds, Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX
  1. Mark.Wilcox{at}Leedsth.nhs.uk

    Rapid screening is no more effective at reducing acquisition than conventional screening

    Controversy about the effectiveness of screening for meticillin resistant Staphylococcus aureus (MRSA) stems from the scarcity of robust data from controlled studies. Typically, studies supporting screening have used multiple control measures to curtail hospital outbreaks of MRSA and have lacked control groups.1 The effectiveness of screening depends on key factors including compliance with and sensitivity of screening, capacity to isolate or form cohorts out of identified MRSA carriers, efficacy of decolonisation regimens, and compliance with standard infection control precautions (such as hand hygiene, aseptic procedures when handling vulnerable sites or devices, and prophylaxis).2 In the accompanying study, Jeyaratnam and colleagues report a randomised controlled trial of the effect of rapid screening for MRSA on acquisition of MRSA on hospital general wards in the United Kingdom.3

    In some healthcare systems—for example, in the Netherlands—MRSA screening has helped maintain low MRSA colonisation and infection rates. However, in MRSA endemic settings in the UK, the demand for isolation facilities (either to segregate known MRSA carriers or those at high risk) often exceeds availability.4 This compromises one of the main principles of controlling the spread of healthcare associated pathogens.

    Furthermore, the efficacy of MRSA decolonisation is suboptimal and may be exacerbated by resistance to mupirocin, …

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