Comprehensive Strategy to Prevent Nosocomial Spread of Methicillin-Resistant Staphylococcus aureus in a Highly Endemic Setting

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Abstract
The first strain of methicillin-resistant Staphylococcus aureus (MRSA) was detected in the United Kingdom in 1961.1 In subsequent decades, MRSA has rapidly spread throughout the world and has become highly endemic in many health care institutions.2-5 However, major variance in the ability to control MRSA has occurred with different strategies.6 In a laboratory-based survey conducted between 1990 and 1991 in 10 European countries, the proportion of MRSA among all S aureus isolates varied from less than 1% in Scandinavia to greater than 30% in France, Italy, and Spain.7 Similar results were found in a recent survey conducted in 15 European countries between 1997 and 1999, with prevalence rates ranging from 2% in the Netherlands and Switzerland to greater than 40% in Italy, Portugal, and Turkey.8 Interestingly, high variability in MRSA prevalence has also been found among different institutions in a given geographic area and even among different hospital wards of comparable size and patient case mix.9-15 These variations may reflect a combination of different management approaches and infection control guidelines, surveillance practices, awareness of the problem, legislative requirements, financial and personnel resources, and experience.