In their paper on measures for control of vancomycin-resistant S. aureus, Edmond and colleagues [1] thoroughly review the measures that should be followed to prevent nosocomial transmission of these strains. However, they state that their proposals are based on the limited data available on the control and transmission of S. aureus. In the Netherlands, we have experience with control of methicillin-resistant S. aureus. Since 1988, ongoing surveillance by the National Institute of Public Health and Environmental Protection shows that in the Netherlands (a country that has 15 million inhabitants and about 150 hospitals), the number of cases of methicillin-resistant S. aureus remains constant at approximately 200 per year [2, 3]. Because there is no reason to assume that the epidemiology of methicillin-resistant S. aureus differs from that of vancomycin-resistant strains, we believe that our success provides a good basis for the control of vancomycin-resistant S. aureus.

National guidelines have been issued by a Working Party on Infection Control and endorsed by the National Health Council [4]. The general principles of the guidelines for control of methicillin-resistant S. aureus concur with those proposed by Edmond and colleagues [1]. The main differences are the following: 1) Because S. aureus often manifests in the anterior nares and because of the possibility of shedding, we require that a mask be worn by anyone entering the isolation room; 2) we do not do environmental cultures; 3) we avoid unnecessary diagnostic procedures that require the patient to leave the isolation room but do not avoid these procedures when they are required [we believe that patients colonized with methicillin-resistant S. aureus have the same right to good medical care as do other patients], and precautions are taken for patients leaving the room; and 4) we do not advise special precautions for handling patient specimens or take any additional measures in the microbiology laboratory (we have had no evidence of transmission of methicillin-resistant S. aureus in the laboratory).

We agree with Edmond and colleagues that prevention is better than cure and that infection-control guidelines should be instated before a problem arises. We hope that the Dutch experience might help.