Intensive Care Units (ICU’s) are often considered the genesis units for antibiotic resistance because of high levels of antibiotic use, while poor compliance with infection control measures ensures maintenance and spread of this resistance. In this context MRSA is no exception and many ICUs describe very high rates. A recent systematic review and HTA report in the UK cast doubt on the evidence base for MRSA admission screening and patient isolation, both key parts of search and destroy programmes for MRSA control. A widely reported, well designed study from London cast further doubt on the role of these measures to control MRSA in the ICU.

A review of the literature gives some clues as to the reasons for the failure of this latter study and suggests infact, that screening and isolation, as part of a full search and destroy programme, is likely to control MRSA in the ICU. Particular emphasis must, however, be put on the robustness of isolation measures which seem particularly difficult to maintain. Most studies in the ICU that report success of search and destroy bolster their isolation procedures by some sort of patient decontamination procedure such as nasal mupirocin and/or chlorhexidine washes. There is increasing evidence that such measures not only reduce the hazard MRSA positive patients pose to others but also to themselves.