MRSA management strategies in acute care hospitals: a systematic review

Abstract

The aim of this systematic review (SR) was to identify and critically appraise the best available research evidence regarding the infection control strategies used to manage nosocomial outbreaks and endemic methicillin resistant Staphylococcus aureus (MRSA) within the acute hospital setting. A thorough search of the literature identified 60 potential papers; however, only 33 studies met the quality criteria and were therefore considered the best evidence for inclusion in the review. Various strategies such as staff, patient and environmental surveillance, patient isolation, flagging of medical records, use of protective apparel, education programmes for staff and monitoring of compliance with infection control practices, have been adopted to control transmission of infection during an epidemic. Medical staff, nurses and respiratory therapists were identified as sources of transmission during outbreaks. Researchers have demonstrated that between 1?20% of staff screened during an epidemic and up to 44% of staff working in areas where MRSA is endemic were colonised. Prospective patient surveillance indicated that a large number of patients were colonised without the symptomatic presentation of clinical illness. This SR indicates that, in an attempt to curtail the spread of MRSA, various combinations of strategies have been beneficial. However, the effectiveness of the strategies used will depend on the patient demographics, acuity and size of the institution and the resources available.