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Strategies for controlling methicillin-resistant Staphylococcus aureus in hospitals.

In areas where the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) is very low, aggressive strategies, which appear to have been effective, such as those used in the Netherlands and western Australia, may be feasible. In hospitals where MRSA is epidemic or highly endemic, less rigorous strategies are appropriate. However, which isolation techniques and barrier precautions are optimal is controversial. In addition, there is no consensus regarding the epidemiological importance of environmental contamination. Rapid detection of MRSA, prompt implementation of barrier precautions and prospective surveillance are essential components of a successful control programme. Eradicating nasal carriage of MRSA among patients and personnel can be useful during epidemics, but the cost-effectiveness of using this approach in hospitals where the prevalence of MRSA is low is unknown. Additional studies of this issue need to include surveillance for mupirocin-resistant strains.