A recent article and editorial in the New England J. Medicine may have answered the question as to how best to deal with the question of MRSA infections in hospital admissions.
The study design as published in the New England J. Med [368:2255-226, 2013] was as follows:
"We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients)." (Note: Universal decolonization was accomplished with intranasal mupirocin for 5 days and chlorhexidine bathing for the entire ICU stay.)
An editorial in the same issue of NEJM concludes:
"The implications of this study are highly important. The lack of effectiveness of active detection and isolation should prompt hospitals to discontinue the practice for control of endemic MRSA. A benefit will be a reduced proportion of patients requiring contact precautions, which is a patient-unfriendly practice that interferes with care. In addition, the folly of pursuing legislative mandates when evidence is lacking has been shown, and laws mandating MRSA screening should be repealed.
Lastly, this study has implications beyond MRSA. New resistance mechanisms continue to emerge in nosocomial pathogens. The recent dissemination of carbapenem-resistant Enterobacteriaceae has stimulated calls to implement active detection and isolation for these organisms. We hope that the results of this study will redirect that discussion and reinforce the utility of horizontal interventions to control not only the pathogens of today but those of tomorrow as well."