Screening and isolation of methicillin-resistant Staphylococcus aureus (MRSA) colonized patients is widely practiced in UK critical care units but little benefit is perceived

Colonization with MRSA has been shown to be associated with increased length of ICU stay and increased nursing workload in the critically ill patient [1]. Screening and isolation of colonized patients have been recommended [2], but this is becoming increasingly difficult [3]. Furthermore this practice derives from recommendations of cohort isolation of general ward patients rather than individual isolation of the critically ill [2]. We therefore decided to assess practice in ICU and CCU by postal survey.

Postal surveys were sent to 193 units across England and Wales. Replies were received from 98 units (51%). A follow-up survey was then sent out and replies received from 57 (30%). National guidelines were used alone in 70% (70/98). MRSA colonization was flagged up in 73% (72/98). Colonization was perceived to be increasing in 37% (21/57) and decreasing in 11% (6/57). Routine screening of patients was performed in 54% (53/98). This was performed immediately in 51% (22/43); within 24 hours in 44% (19/43) and on designated days in 5% (2/43). A policy for screening of elective admissions existed in 49% (48/98), however this was felt to help rates of colonization in only 23% (9/38). Routine staff screening was performed in only 2% (2/98). Isolation of MRSA colonized patients occurred in 69% (68/98). This was thought to be effective or to eliminate cross infection in 42% (29/68) and not effective in 15% (14/68). Isolation was not used because it was not felt necessary in 37% (11/30) or because of a lack of resources in 60% (18/30). In units using isolation 19% (11/57) felt this decreased colonization. Increases in inter-hospital transfers were felt to be a cause of increased colonization in 44% (25/57).

National guidelines were widely used, however despite recommended routine screening in certain patients this only occurred in half the units sampled. Despite the frequent use of isolation only 42% of these felt it effective and only 19% had seen a reduction in colonization rates associated with the use of isolation. 37% of those not using isolation did not believe it of value, but 60% did not use isolation due to lack of resources. Overall these figures help suggest that there are considerable resource implications from isolating MRSA colonized patients, but whilst this is common practice its efficacy is not universally perceived and is only rarely associated with reduced colonization.