Committee to Reduce Infection Deaths Objects to JAMA Article on Universal Screening for MRSA

NEW YORK The Committee to Reduce Infection Deaths (RID) says that a new study(1) on universal screening appearing in the Journal of the American Medical Association (JAMA) is flawed. The article suggests that screening for methicillin-resistant Staphylococus aureus (MRSA), a simple skin or nasal swab, is not effective in reducing MRSA-related hospital-associated infections (HAIs).

RID notes in its press release, Researchers used a rapid test, but many patients were not tested until they had already been in the hospital for twelve hours. Furthermore, the results of the MRSA tests were not acted upon for another 22½ hours on average. Most patients had completed more than half of their hospital stay before their results were known. Therefore, the precautions they needed -- isolation, proper antibiotics, chlorhexidine baths -- were taken late or not at all.

The RID press release continues, Unbelievably, almost a third of surgical patients (31 percent) who tested positive didnt get their test results until after their surgery. Therefore they too didnt receive any of the precautions they needed. Some people carry MRSA germs in their noses or on their skin without realizing it. The bacteria do not cause infection unless they get inside the body -- usually via a catheter, a ventilator, or an incision or other open wound. No weekly MRSA testing was conducted, which is de rigour when conducting universal screening to prevent patients colonized with MRSA from passing it on to other patients in the hospital. A previous study by the same lead author at the same location, the University of Geneva Hospital, found that universal screening on admission with preemptive contact precautions (the way its supposed to be done) decreased MRSA infections in the medical intensive care unit.

Betsy McCaughey, chairman of RID and former lieutenant governor of New York, states, The study released today doesnt prove that MRSA screening is ineffective. The study omits the precautions that are supposed to follow a MRSA positive test result. Its like testing a recipe, but omitting half the ingredients or test-driving a car without the tires.

RIDs press release says, Todays JAMA article provides false support for the CDCs persistent do-nothing position on the dire problem of MRSA. The CDCs lax guidelines continue to give hospitals an excuse to do too little.

Reference: 1. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA. Vol. 299, No. 10. March 12, 2008.

Source: Committee to Reduce Infection Deaths