Strategies to contain methicillin-resistant Staphylococcus aureus will fail unless they include screening all health care workers and decolonizing carriers, say Dutch researchers.
The Netherland's strict “search and destroy” tactics, which include staff screening, have kept its MRSA infection rates lower than in other European countries, including the UK.
In England, more than 40% of S. aureus bloodstream infections are now methicillin resistant, up from 2% in 1994. This is one of the highest rates in Europe, compared with 1% in The Netherlands.
In Canada, the incidence of MRSA, as a proportion of S. aureus isolates, increased from 1% in 1995 to 8% in 2000 (CMAJ 2002;167[8]:885-91).
In December 2003, Sir Liam Donaldson, England's chief medical officer, issued guidelines for the National Health Service aimed at improving infection control.
But a National Audit Report issued 6 months later called implementation of the government's infection control strategy “patchy.”
Efforts to control MRSA in Canada include reducing inappropriate prescribing and reducing transmission through enhanced infection control and environmental hygiene.
Dutch doctors say these strategies alone won't work if they neglect extensive screening.
“Health care workers are one of the main routes of transmission of resistant bacteria, including MRSA,” says Heiman Wertheim, a research scientist at Erasmus University Medical Centre's department of microbiology and infectious diseases in Rotterdam. “So if you forget to screen them and you don't treat the carriers, your MRSA infection control policy will fail.”
Professor Andreas Voss of the University Medical Centre St. Radboud, in Nijmegen, adds that infection control strategies will fail unless they include both health care worker screening and decolonization: treating colonized patients with antibiotics to rid them of the infection.
In addition to screening staff, the MRSA “search and destroy” control strategies used in the Netherlands include isolating infected patients and closing wards for extensive cleaning if an outbreak occurs. — Colin Meek, Wester Ross, Scotland