Would active surveillance cultures help control healthcare-related methicillin-resistant Staphylococcus aureus infections?

In 1934, Reinhold Niebuhr penned lines that could almost serve as a mantra for healthcare epidemiology: "God give us grace to accept with serenity the things that cannot be changed, courage to change the things which should be changed and wisdom to distinguish the one from the other." In the same year, however, T. S. Eliot wrote lines that also resonate strongly and appear to many to sometimes represent a better description of what is actually happening: "Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?" Conflicts about what can and should be changed and the knowledge and wisdom to recognize these situations seem to be what healthcare epidemiology is all about. In this issue, the Rhode Island Best Practice Guideline for controlling methicillin-resistant Staphylococcus aureus (MRSA) addresses the control of one of the major causes of antibiotic-resistant healthcare-associated infections in U.S. hospitals. National secular trend data since the early 1980s have shown that the prevalence of MRSA keeps increasing every year (Fig. 1). The Centers for Disease Control and Prevention (CDC) has estimated that approximately 13,300 Americans died in 1992 of healthcare-associated infections caused by antibiotic-resistant pathogens. The rates of such infections (and of deaths directly or indirectly caused by these infections) have continued to rise each year. This means that, during the past decade, approximately 130,000 to 150,000 patients have died of these infections in U.S. hospitals. It should be remembered that control of healthcare-associated antibiotic-resistant pathogens was the reason that infection control programs were created in the first place, back in the early 1970s. This had followed two decades of steady increases in 45 -