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Practice Practice Pointer

Screening for meticillin resistant Staphylococcus aureus (MRSA): who, when, and how?

BMJ 2014; 348 doi: (Published 27 February 2014) Cite this as: BMJ 2014;348:g1697
  1. John E Coia, consultant microbiologist1,
  2. Alistair T Leanord, consultant microbiologist Health Protection Scotland2,
  3. Jacqui Reilly, lead consultant, professor of healthcare associated infection23
  1. 1Department of Clinical Microbiology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
  2. 2NHS National Services Scotland, Meridian Court, Glasgow G2 6QE, UK
  3. 3Glasgow Caledonian University, Glasgow, G4 0BA, UK
  1. Correspondence to: J E Coia john.coia{at}

Summary points

  • Controversy exists over the optimal strategy and extent of screening for meticillin resistant Staphylococcus aureus (MRSA)

  • Individual clinicians must be aware of, and comply with, local screening and management policies for MRSA colonised patients

  • Standard screening swabs should include (a) a nasal swab and a perineal swab or (b) a nasal swab and a throat swab as the minimum

  • Screening identifies colonised or infected patients who can then be managed to decrease spread of MRSA, including contact precautions, decolonisation, and isolation

  • Screening results need to be available in a timescale that allows effective intervention to reduce risk of infection in individual patients and prevent transmission to others

Meticillin resistant Staphylococcus aureus (MRSA) remains one of the foremost nosocomial pathogens. The changing epidemiology and microbiology of MRSA worldwide provides an important context for decision making with regard to infection prevention and control. MRSA can be categorised as hospital associated, community onset, community associated, or livestock associated. This article concentrates on hospital associated MRSA, although both community associated and livestock associated MRSA are important emergent threats.

Patients colonised or infected with MRSA provide a reservoir within hospitals. Transmission occurs directly from patient to patient, indirectly via the hands of hospital staff after contact with a patient who is colonised or infected, or after handling contaminated materials,1 or by direct patient contact with the contaminated environment.

Infection prevention and control measures minimise risk of transmission to prevent healthcare associated infection. Although there is broad agreement on the control measures required for patients colonised or infected with MRSA, there is considerable controversy over the optimal strategy and extent of screening that should be undertaken.


We undertook a literature review using search terms from a previous systematic review of MRSA screening2 and updated to June 2013. We searched Medline and the Cochrane Library …

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