Hospital based clearance of patients with skin and soft tissue methicillin resistant Staphylococcus aureus (MRSA): A systematic review of the literature

Abstract

Objectives To systematically review the reported processes associated with hospital based screening and subsequent clearance of patients diagnosed with skin or soft tissue infection (SSTI) associated with methicillin-resistant Staphylococcus aureus (MRSA). Methods A systematic review of published and grey literature following the guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), between 2000 and 2015. Results The electronic search identified 1128 citations using CINAHL, Medline and the Cochrane library databases from which relevant studies were selected for review. The potential relevance for SSTI MRSA clearance was further evaluated and 1066 citations were excluded. The remaining 62 full text articles were reviewed with 10 meeting the primary inclusion discussing MRSA clearance (n = 9204 patient numbers). Of the ten full articles, intervention techniques employed for MRSA clearance swabbing included five studies employing Agar culture swabs, one using only polymerase chain reaction (PCR) swabbing, and three studies analysed both types of swabbing techniques. Nine articles were retrospective qualitative studies with evidence hierarchy III and IV, while one study was a randomised control trial (RCT) with evidence hierarchy II [1]. All of the articles reported using selective screening programs targeting SSTI of MRSA patients, however there was no consistency identified between MRSA screening techniques. Conclusion Current literature utilising SSTI MRSA clearance process delivers no irrefutable recommendations or guidelines for consistent and effective SSTI MRSA clearance procedures. The Australian Guidelines for the Prevention and Control of Infection in Healthcare [2] provides guidelines for the processes involved in patient MRSA clearance and discontinuing contact precautions (CP), however there is variability within individual Australian State interpretation of the guidelines and State managed infection control practices. To reduce cost associated with CP and prevent adverse events for patients, further studies are required to identify best practice in regards to SSTI MRSA clearance techniques, such as the swabbing process or the scheduling of the swabs.