Methicillin-resistant Staphylococcus aureus outbreak: a consensus panel's definition and management guidelines.
OBJECTIVE
To provide medical personnel with a definition of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) and guidelines for managing potential outbreaks.


METHODS
Eighteen panel members were chosen from different specialties, types of institutions, and geographic regions. Representatives from the American Society of Consultant Pharmacists, the American Society of Health-Systems Pharmacists, the Society for Healthcare Epidemiology of America, and the National Association of Directors of Nursing Administration participated.


METHODS
In preparation for the conference, panel members reviewed the literature and wrote abstracts outlining their personal opinions on the core issues, which were circulated to all participants. During a weekend conference, the panel summarized the reviewed literature, defined an MRSA outbreak, and developed management guidelines.


METHODS
Published literature, clinical experience, and expert opinion concerning the emergence and subsequent management of MRSA cases in health care institutions.


RESULTS
An outbreak of MRSA was defined as either an increase in the rate of MRSA cases or a clustering of new cases due to the transmission of a single microbial strain in the health care institution. An increased rate of cases can be defined statistically or experientially and includes both infected and colonized patients. A potential outbreak should trigger stepwise, multidisciplinary actions consisting of basic epidemiologic procedures (phase I) to form an initial epidemiologic hypothesis of an outbreak (phase II) followed by a standard epidemiologic workup (phase III) and microbiologic studies (phase IV) to confirm the hypothesis. Mupirocin calcium treatments should be considered to decolonize health care workers during the fourth phase, even before typing is completed.


CONCLUSIONS
Until studies can be conducted to delineate the effectiveness of different recommendations, the proposed guidelines may provide a useful starting point that can be adapted to meet an individual institution's specific needs.
Wenzel
R P
RP
Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0663, USA.
Reagan
D R
DR
Bertino
J S
JS
Baron
E J
EJ
Arias
K
K
D004196:Disease Outbreaks / Q000517:prevention & control*; D017408:Guidelines as Topic; D006757:Hospital Units; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016106:Methicillin Resistance; D008828:Microbiological Techniques; D009666:Nose / Q000382:microbiology; D011159:Population Surveillance; D013048:Specimen Handling / Q000379:methods; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology