The new Eurosurveillance website is almost here.

Eurosurveillance is on the updated list of the Directory of Open Access Journals and in the SHERPA/RoMEO database. Read more here.

On 6 June 2017, the World Health Organization (WHO) published updates to its ‘Essential Medicines List’ (EML). Read more here.

Follow Eurosurveillance on Twitter: @Eurosurveillanc

In this issue

Home Eurosurveillance Edition  2014: Volume 19/ Issue 37 Article 4
Back to Table of Contents
Previous Download (pdf)

Eurosurveillance, Volume 19, Issue 37, 18 September 2014
Letter to the editor: Preventing nosocomial MRSA infections by screening
  1. Erasmus University Medical Centre, Rotterdam, the Netherlands

Citation style for this article: Verbrugh HA. Letter to the editor: Preventing nosocomial MRSA infections by screening. Euro Surveill. 2014;19(37):pii=20901. Article DOI:
Date of submission: 07 September 2014

To the editor: The systematic literature analysis and review by R Köck et al. [1] on targeted preventive measures to limit infections by meticillin-resistant Staphylococcus aureus (MRSA) is well done but surprisingly did not include the single most extensive intervention published to date, i.e. the Veterans Affairs (VA) initiative to combat MRSA in their acute care hospitals in the United States [2]. The introduction in the summer of 2007 of active screening, followed by contact isolation of positive patients, led to an impressive 62% decrease in MRSA infection in their intensive care units (ICUs) and a 45% reduction in non-ICU wards by the end of 2010. These reductions in MRSA infection rates were sustained and even reached 72% for ICU’s and 65% for non-ICU’s by June 2012 [3]. Nation-wide, virtually all (150/153) VA hospitals participated in this effort and millions of patients were screened, far surpassing the combined experiences of all studies that were included in the Köck review. Of note, such rapid positive effects of active MRSA surveillance and contact isolation are concordant with the predictions previously made by Bootsma et al. from their complex modelling of the MRSA epidemiology in acute care hospitals [4]. Interestingly, the same intervention was applied to all the 133 VA long term care facilities in 2009 and this led to a 36% reduction in MRSA infections in these facilities by the end of 2012 [5]. In that latter intervention, 12.9 million resident days were monitored.

The first evaluation of the VA initiative was mentioned by Köck et al., but only briefly in the discussion section of their review (reference 99 in their paper), but it remains to be explained why the VA initiative’s experience was not included in the body of the review and presented in the Tables. The fact that the VA initiative was not primarily designed as a study but as a real-life intervention does not make it irrelevant for this review. The intervention was well executed (with very high compliance rates), closely monitored and did have pre- and post-intervention phases. As stated by Köck et al., very few randomised controlled trials have been done on MRSA control, and most data included in their Tables were derived from similar quasi-experimental observational studies [1]. As the Review is now, the readership may fail to learn about the highly instructive VA MRSA prevention initiative.

Conflict of interest
None declared.


  1. Köck R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al. Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus. Euro Surveill. 2014;19(29):pii=20860.
  2. Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl LA, Obrosky DS, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med. 2011;364(15):1419-30.
  3. Evans ME, Kralovic SM, Simbartl LA, Freyberg RW, Obrosky DS, Rosell GA,et al. Veterans Affairs methicillin-resistant Staphylococcus aureus prevention initiative associated with a sustained reduction in transmissions and health care-associated infections. Am J Infect Control. 2013;41(11):1093-5.
  4. Bootsma Mc, Diekman O, Bonten MJ. Controlling methicillin-resistant Staphylococcus aureus:quantifyingthe effects of interventions and of rapid diagnostic testing. Proc Nat Acad Sci USA. 2006;103(14):5620-5.
  5. Evans ME, Kralovic SM, Simbartl LA, Freyberg RW, Obrosky DS, Rosell GA,et al. Nationwide reduction of health care-associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities. Am J Infect Control. 2014;42(1):60-2.

Back to Table of Contents
Previous Download (pdf)

The publisher’s policy on data collection and use of cookies.

Disclaimer: The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal. The information provided on the Eurosurveillance site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Our website does not host any form of commercial advertisement. Except where otherwise stated, all manuscripts published after 1 January 2016 will be published under the Creative Commons Attribution (CC BY) licence. You are free to share and adapt the material, but you must give appropriate credit, provide a link to the licence, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

Eurosurveillance [ISSN] - ©2007-2016. All rights reserved

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.