Does a patient with a suspected or confirmed case of Methicillin-resistant Staphylococcus aureus (MRSA) need to be investigated by an infection prevention committee?

MRSA Cases and Infection Prevention Committee Investigation

Direct Answer

MRCoNS (Methicillin-Resistant Coagulase-Negative Staphylococci) does not typically require investigation by an infection prevention committee, as it differs fundamentally from MRSA (Methicillin-Resistant Staphylococcus aureus). However, if your question concerns MRSA specifically, then yes—MRSA cases should be investigated and managed through infection control structures, though the extent depends on institutional prevalence and transmission patterns.

Clarification: MRCoNS vs MRSA

The question mentions "MRCoNS," which refers to methicillin-resistant coagulase-negative staphylococci, not MRSA. These are distinct organisms:

• MRCoNS: Generally considered contaminants or low-virulence pathogens, not subject to the same infection control protocols as MRSA
• MRSA: A significant nosocomial pathogen requiring active infection control measures 1

If the Question Concerns MRSA

When Infection Prevention Committee Involvement Is Warranted

MRSA cases require infection control oversight through established hospital structures, including prevention committees or infection control teams 1, 2. The level of investigation depends on:

High-Priority Situations Requiring Active Investigation:

• Two or more patients colonized/infected with the same strain (constitutes an outbreak in low-prevalence settings like the Netherlands) 1
• Evidence of ongoing nosocomial transmission despite standard control measures 1, 3
• New MRSA cases in previously low-prevalence units (e.g., ICUs, surgical wards) 1
• Clusters of cases suggesting common source or breakdown in infection control 4, 3

Standard Oversight (Not Necessarily Full Investigation):

• Sporadic cases in high-prevalence settings where MRSA is endemic 1
• Single cases with clear community acquisition 1
• Known colonizers without evidence of transmission 5

Role of Infection Prevention Structures

All hospitals should have infection control programs with defined governance structures to manage MRSA 1, 3. These programs should:

• Conduct surveillance to identify cases and monitor trends 1
• Implement screening protocols for high-risk patients (those with prior MRSA, transfers from high-prevalence facilities, skin ulcers) 1, 4
• Ensure isolation and cohorting of colonized/infected patients 1
• Monitor compliance with hand hygiene and contact precautions 1
• Coordinate decolonization efforts when indicated 1, 4
• Provide education to healthcare personnel about MRSA policies 1, 2

Investigation Components

When investigation is warranted, the infection prevention team should:

• Determine the source and reservoir of MRSA (patient carriage sites, environmental contamination) 4
• Identify transmission pathways (typically via transiently contaminated hands of personnel) 4
• Assess compliance with basic infection control measures 3
• Consider molecular typing to confirm clonal relatedness in suspected outbreaks 3
• Implement targeted interventions based on findings 1, 3

Common Pitfalls to Avoid

• Do not assume all MRSA cases require full outbreak investigation—endemic cases in high-prevalence settings need standard management, not investigation 1
• Do not neglect basic infection control measures (hand hygiene, contact precautions) while focusing on complex investigations 1, 3
• Do not implement screening programs without clear protocols for acting on results 6
• Avoid over-reliance on contact precautions alone—recent evidence questions their necessity as an "essential" practice in all settings 7

Resource Considerations

The intensity of infection prevention committee involvement should match institutional MRSA prevalence 1, 3:

• Low-prevalence settings (like the Netherlands): Aggressive "search-and-destroy" approach with investigation of every case 1
• High-prevalence settings: Focus on preventing transmission through standard measures rather than investigating every case 1
• Intermediate settings: Risk-stratified approach with targeted surveillance and investigation of clusters 1

Essential vs. Additional Measures

All institutions should have basic infection control infrastructure 1:

• Infection control team with executive authority 1
• Surveillance systems to detect cases 1
• Protocols for isolation, hand hygiene, and environmental cleaning 1
• Antibiotic stewardship programs 1
• Staff education programs 1, 2