WHEN SHOULD HEALTH-CARE WORKERS BE SCREENED FOR METHICILLIN-RESISTANTSTAPHYLOCOCCUS-AUREUS

The role of screening of healthcare workers (HCWs) in the control of m ethicillin-resistant Staphylococcus aureus (MRSA) is controversial. It is recommended in guidelines by expert groups in both North America a nd the United Kingdom, although the role of MRSA carriage by HCWs in o utbreaks is not clearly defined. The present report describes the spre ad of a distinct strain of MRSA to patients by a single HCW on three s eparate occasions over 27 months. The isolates from this HCW and patie nt contacts were shown to be indistinguishable by antibiogram and repe titive extragenic palindromic polymerase chain reaction (REP/PCR); non e were typeable by lytic phage-typing. Throat carriage of the MRSA pro bably recurred in this HCW, despite attempts to eradicate it on three occasions. Over the same period, nine other small clusters were seen i n the Oxford Hospital Group, involving 66 patients and 22 HCWs coloniz ed, or occasionally infected, with a variety of MRSA strains. In none of these instances could HCWs be implicated in the initiation of an ou tbreak. The advantages of a screening policy include the determination of the full extent of MRSA-colonization and work exclusion; the disad vantages include detection of transient nasal carriage, disruption of staff routine and stigmatization. Screening of HCWs can be a valuable tool in the control of MRSA outbreaks but it should be used selectivel y. This strategy remains an important part of a control programme.