The debate about how aggressively hospitals should conduct hospitalwide surveillance got much louder with the April 14 publication of two studies in The New England Journal of Medicine. Rather than clarify the issue, the studies confused it.
The first report involved nearly two million patients at 150 hospitals in the Veterans Affairs healthcare system. It showed that a combination approach of nasal swab testing within 24 hours of admission, contact precautions, hand hygiene, and “institutional culture change” resulted in a 62% drop in the rate of hospital-acquired MRSA infections in the VA’s ICUs.
The second study, led by the Mayo Clinic in Rochester, MN, involved universal testing for MRSA and vancomycin-resistant enterococcus (VRE) in 9,000 patients admitted to 18 ICUs. The study employed barrier precautions such as gowns and universal gloving and hand-washing. But it found that the bundle of interventions was not effective in reducing MRSA or VRE colonization.
“This finding was surprising, given the surveillance cultures identified a sizeable subgroup of colonized patients who were not otherwise recognized,” the authors wrote.
Michael Edmond, MD, hospital epidemiologist at Virginia Commonwealth University Medical Center, acknowledges that the arguments are getting louder. “These active surveillance [efforts] may work in some settings. But the message that some people have tried to really get out there, and which I think is totally false, is that the only way to control MRSA is to do that. And I think that’s not true at all.”