Guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus

The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus

Healthcare workers may acquire methicillin-resistant Staphylococcus aureus (MRSA) from patients, both hospital and home environments, other healthcare workers, family and public acquaintances, and pets. There is a consensus of case reports and series which now strongly support the role for MRSA-carrying healthcare personnel to serve as a reservoir and as a vehicle of spread within healthcare settings. Carriage may occur at a number of body sites and for short, intermediate, and long terms. A number of approaches have been taken to interrupt the linkage of staff-patient spread, but most emphasis has been placed on handwashing and the treatment of staff MRSA carriers. The importance of healthcare workers in transmission has been viewed with varying degrees of interest, and several logistical problems have arisen when healthcare worker screening is brought to the forefront. There is now considerable support for the screening and treatment of healthcare workers, but it is suggested that the intensity of any such approach must consider available resources, the nature of the outbreak, and the strength of epidemiological associations. The task of assessing healthcare personnel carriage in any context should be shaped with due regard to national and international guidelines, should be honed and practiced according to local needs and experience, and must be patient-oriented.

Endemic methicillin-resistant Staphylococcus aureus in a special care baby unit: a 2 year review

During January 1987, methicillin-resistant Staphylococcus aureus (MRSA) was isolated for the first time from a baby admitted to the special care baby unit of a large metropolitan hospital. Over a 2 year period, of 1574 babies admitted to the unit, at least 573 (36.4%) became colonized with the organism. Only nine (1.6%) developed significant infectious morbidity and one baby died. Minor infections occurred in a further 35 (6.1%). The outbreak remained uncontrolled despite rigid infection control measures. Subsequent emphasis on hand washing, in-service education and provision of weekly review of the MRSA colonization rates have failed to eliminate the organism from the unit.