MRSA: why have we got it and can we do anything about it?

MRSA, first identified in 1960, became a major cause of healthcare-associated infection with the emergence of epidemic strains EMRSA 15 and 16 in the 1990s. MRSA bacteraemia surveillance in England showed a peak of 7700 in 2003–2004. A target was set to halve MRSA bacteraemias by 2008 backed by a central improvement programme for infection prevention and control. Healthcare-associated infection is a patient safety issue with joint responsibility between: clinicians responsible for patient care; managers responsible for the organisation of services; and the government/Department of Health responsible for national strategy, prioritisation and performance management, together with introducing a statutory Code of Practice. By 2011, the number of MRSA bacteraemias had reduced by 80% to 1481. The key drivers of improvement were management responsibility, enhanced surveillance, adherence to clinical protocols and care bundles for invasive procedures, hand hygiene and environmental cleaning, and improved isolation procedures and antibiotic stewardship. The target has been translated into an ongoing MRSA objective, and further control of MRSA is supported by a screening programme aimed at all relevant hospital admissions. Sustaining the reduction will depend upon joint responsibility between management maintaining compliance assurance with policies and individual clinicians keeping it as a priority in patient safety.