RSS Feeds
Benefits and Drawbacks of Universal Surveillance of Methicillin-Resistant Staphylococcus aureus
- Lance R. Peterson, MD;
- Jennifer L. Beaumont, MS; and
- Ari Robicsek, MD
- From Evanston Northwestern Healthcare, Evanston, IL 60201.
IN RESPONSE:
The letter by Dr. Diekema raises several items for discussion. We regret that he found our title misleading. As indicated in our article, the program's critical and enforced aspect was universal admission surveillance. Decolonization was at the attending physician's discretion. We routinely culture all positive polymerase chain reaction samples for MRSA and test isolates for mupirocin resistance, which occurred in 5.6% of strains before universal surveillance began and 4.1% at the end of the program's first year (1). In addition, to minimize the potential for resistance, we removed mupirocin for clinical use other than for nasal decolonization.
The overall impact of isolation on patient care is an important question. Some reports, none of which are randomized trials, have suggested a possible negative impact on the isolated patient. The cited review by Diekema and colleagues (2) references the report by Stelfox and colleagues, which seems to demonstrate more adverse events in isolated patients as well as fewer acceptable process-of-care measures (3). However, there were unacceptably high lapses in care of patients in the control (unisolated) group as well, with 21% to 41% having days with no vital signs recorded as ordered, 9% to 11% having days with no nursing notes, and 2% to …
