SELECTIVE SCREENING OF CARRIERS FOR CONTROL OF METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS (MRSA) IN HIGH-RISK HOSPITAL AREAS WITH A HIGH LEVEL OF ENDEMIC MRSA

Screening for methicillin-resistant Staphylococcus aureus (MRSA) carri age in patients at risk was evaluated as part of a control program in a 26-bed medical intensive care unit (ICU) of a university hospital wi th a high level of endemic MRSA. Control measures included isolation a nd barrier precautions, skin decolonization with chlorhexidine of pati ents from whom MRSA was recovered, and mupirocin treatment of nasal ca rriers of MRSA. Of 3,686 patients admitted during a 4-year period, 44% were screened, which occurred during admission for 38%; MRSA was reco vered from 293 patients (8%). There were 150 imported cases and 143 IC U-acquired cases, of which 51% and 45%, respectively, were first ident ified through screening. Nasal swab cultures identified 84% of MRSA ca rriers. The incidence of all ICU-acquired cases and of acquired coloni zation or infection decreased from 5.8% and 5.6% to 2.6% and 1.4% (P = .002 and P < .001), respectively, whereas that of imported cases rema ined unchanged (range, 3.8% to 4.3%; P = .8). Selective screening for nasal carriage during admission to high-risk areas may contribute to i dentification of a substantial proportion of cases of MRSA and to earl y implementation of effective control measures.