Epidemic methicillin-resistant Staphylococcus aureus (EMRSA): experience from a health district of central England over five years.

A series of outbreaks of EMRSA occurred in three hospitals of a Health District in the years 1986 and 1987, affecting 64 patients and 6 staff members. By the antibiotic sensitivity pattern (methicillin-resistance and resistance to many others) and phage typing, the organism resembled the epidemic strains involved in London outbreaks. In this series of outbreaks, different circumstances led to adaptation of different control measures with their cost implications. As failure with chlorhexidine was experienced, it was replaced with povidone-iodine for routine handwashing and topical application to patients in affected wards. Heavy environmental contamination involving mattress, bed, floor, table, chair, locker, television etc. was shown. Repeated failures of a phenolic disinfectant led to use of formaldehyde or a higher concentration of the phenolic disinfectant which caused side effects in staff members. Various anti-bacterial agents had been used in treating different conditions in different cases. Mupirocin was found to be the best agent in treating infections or colonization of superficial accessible sites. For non-accessible sites fusidic acid and rifampicin were found to be satisfactory. Continued surveillance in the District for three years after the last case did not detect re-emergence of EMRSA.