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This month, the Healthcare Infection Society (HIS) and the Infection Prevention Society (IPS) are pleased to present new NICE-accredited guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. The guideline has been produced by key experts on the front line of patient care, and can be downloaded for free from the Journal of Hospital Infection website here.
MRSA infections remain a serious cause of healthcare-associated infection globally. While the incidence is decreasing, this remains an important concern for infection prevention and control professionals and a vital area of ongoing research.
The published guideline identifies key areas for further research, but if we had a perfect world of limitless research funding, what complementary research questions would the authors of the new guidelines like to see developed? And what might be ready to support the evidence-based recommendations of future guidelines?
“There is a growing body of literature suggesting a proportion of S. aureus carriage remains undetected by conventional culture-based methods. Reasons for this may include intracellular survival, difficult-to-culture phenotypes, and the presence of these bacteria deep in tissues. With S. aureus infections continuing to occur despite broad infection prevention and control practices we need to understand the role of cryptic carriage in carriage and disease development to support screening, prophylactic and preventive measures.”
“Another idea might be the role of the environment in the acquisition and transmission of MRSA. Does enhanced decontamination of surfaces, such as with hydrogen peroxide, result in less acquisition and transmission – what could we find out when these questions are combined with using whole genome sequencing (WGS)? Previous studies did not suggest that they did, and repeating with WGS might be challenging and expensive, but would probably definitively answer this question.”
“Assessments of alternatives to mupirocin and chlorhexidine are required due to the possible emergence of resistance and intolerance to these two agents. Most of the studies to date on these alternatives have been under-powered or flawed in design, but again would be challenging as they would have to be multi-centre – however, we would be looking for non-inferiority rather than superiority.”
“There is something interesting about the data on shared equipment as there are a huge number of studies of equipment, especially stethoscopes which are ‘sampled and grow stuff’. This is valuable, but we know that inevitably if you sample equipment that isn't sterile, you will find bugs on it. The big question is, how relevant is that to transmission? There are very few studies, maybe one or two, which show that having bugs on equipment actually transmits infection – that’s a big gap in the evidence.”
“From a patient perspective, repeating some of the surveys done previously on perceptions about MRSA and healthcare-associated infections, but now in the context and with reference to CDI, CPE, and of course COVID-19, would make for an interesting study. The public are now better educated on aspects of infection prevention and control, for example, hand hygiene, and may be more afraid of COVID-19 than MRSA. Alternatively, the public may be more blasé as there is a vaccine to COVID-19.”
“I've increasingly felt there is a big research gap on the issue of ergonomics and healthcare delivery. We sometimes introduce new equipment without thinking about how we fit it into a pattern of work that supports good infection prevention and control practice. We need more research that better understands those ergonomics of how we drive hand hygiene at the right point. So, for example, putting alcohol at the foot of the bed – that is not within the eye line when we are speaking with or examining the patient. The whole dynamic of how we relate to patients and how we introduce infection prevention and control into this interaction is fascinating – I think that would be really good to study more.”
For more discussion of the current evidence base, and where future research could lead, sign up to our upcoming webinar Spotlight on Guidelines: MRSA screening, surveillance and the environment
Some of these ideas were discussed in the first Spotlight on Guidelines webinar - you can watch it for free here: MRSA: IPC management of patients and staff
The Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities are freely available to read and download here: Guidelines