Compliance of hospital staff with guidelines for the active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) and its impact on rates of nosocomial MRSA bacteremia.

KeY wOrds: m ethicillin-resistant Staphylococcus aureus is a major cause of hospital-acquired infections in many countries around the world [1,2] and in recent years it has become a significant cause of community-acquired infections [3]. A recent study from Israel addressed the role of community acquired-MRSA in pediatric soft tissue infections [4]. In the last decade numerous reviews and consensus statements have endorsed policies to control the spread of nosocomial MRSA infections [5,6]. The most widely addressed policy is perhaps active MRSA surveillance to detect and isolate MRSA carriers among hospital admissions, mainly a subgroup of patients at high risk for MRSA carriage [7,8]. Nevertheless, there is still controversy regarding the role of active surveillance in the control of MRSA infections, with a few systematic reviews suggesting that there are no good data to support this approach [9,10]. In Israel, methicillin resistance among S. aureus isolates is variable. Some authors reported very low rates (~0.6%) of nasal MRSA carriage among healthy children and 7.6% among chronically institutionalized children [11], while others presented rates ranging from 11.4% in community-acquired infections, 27% among hospital-acquired infections, and up to 50% among patients in long-term care facilities [12]. The use of active MRSA surveillance to control nosocomial MRSA infections has been officially adopted by only a few hospitals in Israel. One group published an initial report describing its efficacy [13] and recently published a second report after 5 years of follow-up, proving that rates of nosocomial MRSA bacteremia can be reduced when using active surveillance together with contact isolation and monitoring to ensure compliance with screening and contact isolation guidelines [14]. Our medical center adopted a policy of active MRSA surveillance in 2005, restricted to a subgroup of patients at high risk for MRSA carriage. It is unclear to what extent the medical MRSA = methicillin-resistant Staphylococcus aureus