Author: John Jernigan, M.D
Director for CDC’s Office of HAI Prevention Research and Evaluation, Division of Healthcare Quality Promotion
The optimal approach to controlling MRSA in healthcare facilities has been a topic of ongoing controversy. Of particular interest is the question of whether the use of active detection and isolation of patients colonized with MRSA, also known as ADI, should be routinely used. Despite ongoing research and vigorous scientific debate, a simple answer has remained elusive. This week, two studies were published in the New England Journal of Medicine that illustrate the complexities of the scientific evidence surrounding ADI. One of these studies, the STAR*ICU Trial (Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care), found that ADI as implemented in the study was not effective in reducing transmission of MRSA or VRE. A separate observational study (“Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections“) involving the entire national VA hospital system
, found that after implementing a multifaceted MRSA prevention program that included ADI, MRSA transmissions and HAIs decreased significantly. The fact that these studies seem to give different answers illustrates the challenge we as scientists face in making recommendations on how best to use limited prevention resources-sometimes the answers aren’t simple as we would like.
I do think there are some lessons we can take away from these studies. Together, the study findings are consistent with current belief that MRSA is too complex a problem to be controlled with any single intervention. The VA study suggests that MRSA can be effectively controlled, even on a large scale involving hundreds of hospitals, using a multifaceted intervention strategy. While the strategy chosen by the VA did include use of ADI, the study design does not allow an assessment of the individual contribution of ADI to the overall success.
So what’s the bottom line? The most important message from these studies is that MRSA control, while difficult, is achievable, even if experts may still argue about the best way to do it. In light of the conflicting evidence on the optimal role of ADI, some hospitals may choose strategies that do not include it. Guidelines are available from CDC to help hospitals design an effective MRSA control program. But whatever strategy is chosen, rigorous measurement of the impact of the program should be in place, with the expectation that control of MRSA should be the result.