Supplementary Material 1: Formal Screening Procedures and International Standards

Supplementary Material 1: Formal screening procedures and international standards.

The CDC “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” [1] reports that no recommendations can be made regarding when to discontinue contact precautions; control swabbing is not mentioned. In the ESCMID consensus statement on “Prevention and control of methicillin-resistant Staphylococcus aureus” from 2009 [2], control swabs at the end of a decolonization procedure are not mentioned. The same is true for the British “Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus(MRSA) in healthcare facilities” as stated by the Joint Working Party of the British Society of AntimicrobialChemotherapy, the Hospital Infection Society, and the Infection Control Nurses Association in 2006 [3]. The WHO has not published an MRSA precaution standard of its own. National guidelines published in the national languages are not broadlyaccessible.

In Germany, it is recommended that decolonization of patients carrying methicillin-resistant Staphylococcus aureus (MRSA) be carried out as detailed in a recently updated guideline by the Commission for Hospital Hygiene and Infection Prevention (KRINKO) on behalf of the Robert Koch Institute (RKI), a federal institute of the German Ministry of Health[4]. Verification of the success of decolonization is advised by swabbing of the most frequently colonized sites—i.e., nostrils, pharynx, and wounds—as well as previously colonized sites of the respective patient after the decolonization procedure on three consecutive days [4].

Screening of the perigenital area augments detection of MRSA carriers by 6 to 8% (unpublishedresults of the joint HiCare project), but increases both screening effort and costs as well as patientresistance against the voluntary screening procedure. Therefore, the current German MRSAprecaution guidelines suggest only nose and throat screening and leave perigenital screening asoptional.

1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007Guideline for Isolation recautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

2. Humphreys H, Grundmann H, Skov R, Lucet JC, Cauda R. Prevention and control ofmethicillin-resistant Staphylococcus aureus. ClinMicrobiol Infect, 2009;15:120-4.

3. Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, MallaghanC, Tucker DR, Joint Working Party of the British Society of AntimicrobialChemotherapy, Hospital Infection Society, Infection Control NursesAssociation.Guidelines for the control and prevention of meticillin-resistantStaphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect, 2006;Suppl 1:S1-44.

4. Peters G, Becker K, Briesch H, Hergenroder H, Heudorf U, Just HM, Kock R, Martius J, Wendt C, Wilke F, Mielke M, Hubner NO.Empfehlung zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämme (MRSA) in medizinischen und pflegerischen Einrichtungen – Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 2014;57:696-732.