Fourthly, they depend on different laboratories working to standards and definitions which are both reliable and compatible. SA is spread by direct contact. We are running out of antibiotics. In the UK MRSA can still be treated with vancomycin and a number of other antibiotics. MRSA prevalence varies widely between countries, regions, hospitals, and even individual wards.
Nurses are crucial, since they have most direct contact with patients.
Any survey of MRSA in a hospital must take account of how many carriers brought it in with them. Many serious cases arise from auto-infection, e.g. in a patient already carrying MRSA who undergoes surgery and whose lesions are then invaded as they heal. ARU is trying to move from snapshot surveys, which are resource-intensive, to continuous local monitoring. BSAC and PHLS are currently testing new methods, and PHLS hope to have sentinel laboratories in place by the end of 1998. In the UK resistance has risen to about 4 per cent.