Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe. Many examples have demonstrated that the spread of MRSA within healthcare settings can be reduced by targeted infection control measures. The aim of this systematic literature analysis and review was to summarise the evidence for the use of bacterial cultures for active surveillance the benefit of rapid screening tests, as well as the use of decolonisation therapies and different types of isolation measures. We included 83 studies published between 2000 and 2012. Although the studies reported good evidence supporting the role of active surveillance followed by decolonisation therapy, the effectiveness of single-room isolation was mostly shown in non-controlled studies, which should inspire further research regarding this issue. Overall, this review highlighted that when planning the implementation of preventive interventions, there is a need to consider the prevalence of MRSA, the incidence of infections, the competing effect of standard control measures (e.g. hand hygiene) and the likelihood of transmission in the respective settings of implementation.
Highlights
Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe
Exclusion criteria were: Studies that did not report on the effects of the preventive measures on infection or transmission; studies performed in settings other than hospitals, long-term care facilities and nursing homes; case series, outbreak reports and Figure Flow diagram for the selection of studies on preventive measures against to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus, published 2000–2012 (n=9,340)
We have documented that the evidence for the effectiveness of three major MRSA prevention and control measures does not allow for clear guidance offering ‘one-size-fits-all’ solutions, because the effectiveness of these interventions seems highly depending on the prevalence of MRSA, compliance with general infection control measures, the incidence and type of infections and the transmission rates within the respective setting of implementation
Summary
Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe. The burden of MRSA infections was shown in an analysis of data on healthcare-associated infections collected prospectively from European intensive care units (ICU) between 2005 and 2008, where 1.7% of all patients developed S. aureus pneumonia or bloodstream infections. Among the proposed methods to prevent MRSA, many (e.g. hand hygiene and transmission-based precautions) have been used for general infection control, and their effectiveness has been reviewed extensively [3,4]. There is an ongoing discussion about the evidence for the effectiveness of several more specific prevention methods which, have been included in standards for the prevention and control of MRSA in a majority of European countries [5]. Does screening of patients before or on admission reduce the incidence of MRSA infection or transmission? The scope of this review was to analyse systematically recent literature (published after 2000) with respect to the following questions related to MRSA prevention and control: 1. Does screening of patients before or on admission reduce the incidence of MRSA infection or transmission? How do PCR-based rapid tests for the direct detection of MRSA from screening specimens influence the incidence of MRSA colonisation or infection compared with culture-based methods?
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