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Superbug policies questioned by experts

Lack of evidence over effectiveness of MRSA policies

Adrian O'Dowd

Thursday, 21 August 2014

Experts have raised doubts over how effective current practices are to try and control the superbug meticillin-resistant Staphylococcus aureus (MRSA), in an article* published in The Lancet.

In the journal’s viewpoint article, leading infectious disease experts said the jury was still out on the effectiveness of superbug control policies in hospitals.

In particular, there was a lack of strong evidence to back up the policy of screening and isolating infected patients, which have long been regarded as the gold standard MRSA prevention strategy and are required by law in some countries.

The authors reviewed studies on preventing the spread of MRSA in hospitals over the past decade.

In the article, they argue that although various approaches to tackle MRSA have been examined, most of the research has looked at bundles of control measures, and it is not yet known which individual components work best, or whether some of them could be dropped without increasing transmission.

Gerd Fätkenheuer, study co-author and professor of infectious diseases at the University Hospital Cologne in Germany and president of the German Society of Infectious Diseases said: “In the haste to do something against the rising tide of MRSA infection, measures were adopted that seemed plausible but were not properly assessed, bundling the effective and harmless with the ineffective and harmful.

“We know, for example, that isolating patients can result in anxiety and depression and fewer visits by doctors and nurses.”

Fellow co-author Professor Bernard Hirschel, former chief of the HIV unit at the Geneva University Hospitals in Switzerland and current president of the Swiss Society of Infectious Diseases, added: “We need better studies.

“With the tide of MRSA receding and improved treatment options for the infection, a window of opportunity now exists to reassess whether masks, gowns, gloves, and single rooms add anything to the traditional infection control measures of hand hygiene and universal decolonisation (e.g. a daily bath with an antibacterial agent) which have proved much more successful in reducing rates of MRSA.”

MRSA rates have declined in recent years and hospitals are facing multiple multidrug resistant pathogens, so the authors said the key question now was whether or not scarce resources should focus on screening for one particular pathogen, or take a broader approach focusing on reducing all hospital-acquired infections.

Co-author Professor Stephan Harbarth from Geneva University Hospitals in Switzerland, said: “The lack of effectiveness of active detection and isolation should prompt hospitals to discontinue the practice for controlling the spread of MRSA in favour of evidence-based measures adapted to local conditions and settings, which weigh up effectiveness, costs, and adverse events.

“What is more, recommendations and guidelines should clearly state the uncertainties in this field, and legal mandates that dictate the use of specific control measures for MRSA should be abandoned.”

* Prof Fätkenheuer G, Prof Hirschel B, Prof Harbarth S. Screening and isolation to control meticillin-resistant Staphylococcus aureus: sense, nonsense, and evidence. The Lancet, Early Online Publication, 21 August 2014. doi:10.1016/S0140-6736(14)60660-7.

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