Makoni T (2002) MRSA: risk assessment and flexible management. Nursing Standard. 16, 28, 39-41. Date of acceptance: November 19 2001

THIS ARTICLE argues against the thinking of nurses who still believe in single room containment of every patient affected by methicillin-resistant Staphylococcus aureus (MRSA), despite published evidence to the contrary (Ayliffe et al 2000, Barrett et al 1998). In the light of limited resources, consideration of other single room priorities and the shortage of staff, the author asserts that a rational policy should be based on risk assessment and flexible management. Staphylococcus aureus is a gram-positive coccus, which is present on the skin of approximately 30 per cent of the population (Gould 1995). It is a commensal, generally found in warm and moist parts of the body, such as the nose, throat, groin and axillae. Most patients affected by MRSA are colonised by the bacterium. Colonisation means that the organism lives on specific sites of the body without causing any harm. However, if transferred to an abnormal site, it might cause a wide spectrum of conditions such as boils, carbuncles, wound infections and even life-threatening diseases, for example, endocarditis, osteomyelitis and septicaemia. Since the early 1960s, some strains of Staphylococcus aureus have developed resistance to many commonly used antibiotics, including methicillin and flucloxacillin, which are used to treat infections caused by this organism. This resistance problem poses serious challenges to clinicians, should a patient require treatment. The effects of MRSA on the patient include extended length of stay in hospital, loss of earnings, pain, scarring, anxiety, depression, loss of self-esteem, stigma, reduced quality of life and morbidity. Implications for the hospital include disruption to routine activity, temporary ward closures, increased staff workload, long waiting lists and extra costs for identification and treatment of MRSA, including possible community care costs. MRSA is now endemic in many UK hospitals. The number of people acquiring MRSA infections while in hospital is increasing (Cookson 1997). The demographic changes relating to the ageing population in western countries are likely to mean that the incidence of MRSA will continue to increase. The longer people live, the more likely they are to develop infections due to less effective barrier mechanisms to infection. Older people tend to spend longer periods in hospital, increasing their risk of exposure to MRSA. Meanwhile, the controversy about how best to deal with MRSA continues. Barrett et al (1998) dismissed attempts to control MRSA as disruptive and resource consuming. In contrast, the Joint Working Party of the Hospital Infection Society, the British Society of Antimicrobial Chemotherapy and the Infection Control Nurses Association (Duckworth et al 1998) believes that the control of MRSA is still worthwhile. It argues that control measures do have an impact, and that the costs of ignoring MRSA are higher than those of control. However, the Working Party acknowledges the difficulties faced by infection control personnel in trying to control MRSA and recommends a more flexible approach based on risk assessment.