Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: what have we learned?

Control of methicillin-resistant Staphylococcus aureus (MRSA) still generat es controversy among infection control practitioners. Opponents claim that once MRSA becomes endemic in an institution, control efforts are no longer justified. This review examines the usefulness, feasibility and cost-effect iveness of control programmes in acute-care hospitals where eradication of MRSA has either failed or has never been attempted; hence, the pathogen has become endemic. High endemicity is associated with increased hospital-acqu ired infection rates, increased use of glycopeptides and subsequent risk of emergence of antibiotic-resistant cram-positive bacteria, and additional h ealthcare costs. Thus, MRSA control has many advantages. Indeed, in many in stitutions the actual benefit of containment efforts was manifested through the resultant decrease in the incidence of hospital-acquired MRSA infectio ns. Successful programmes are based on an early identification of the MRSA reservoir and prompt implementation of contact precautions. The most effica cious strategy to detect occult MRSA carriage is via the screening of high- risk patients on admission to the hospital which has proven to be cost-effe ctive in varied acute-care endemic settings. (C) 2001 The Hospital Infectio n Society.