Although the debate continues over what may be the most cost-efficient and necessary approach for prospective monitoring of health care-associated infections, it is clear that surveillance is the first step to understanding and management (Peterson and Brossette, 2002). One way the microbiology laboratory can aid in surveillance is by screening patient admission isolates. MRSA colonization of nares, either present at admission to the hospital or acquired during hospitalization, increases the risk of MRSA infection. Identifying MRSA colonization at admission could target a high-risk population that may benefit from interventions to decrease the risk for subsequent MRSA infection (Davis et al., 2004). However, there remains some controversy on how to best apply the results to infection-control practices. Surveillance cultures and genotyping of MRSA and Methicillin-Resistant Staphylococcus aureus (MSSA) isolates demonstrated the absence of cross-transmission among patients in the medical intensive care unit (MICU), despite ongoing introduction of these pathogens. Reporting culture results and isolating colonized patients, as suggested by some guidelines, would have falsely suggested the success of such infection-control policies (Nijssen et al., 2005). Surveillance may also identify sources of infection before patients are infected such as was seen with a health care worker whose nails harbored an undetected infection passed on to patients (McNeil et al., 2001).
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