Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci:: Position statement from the joint SHEA and APIC task force

Legislation aimed at controlling antimicrobial- resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America ( SHEA) and the Association of Professionals in Infection Control and Epidemiology ( APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare- associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. ( 1) Although reducing the burden of antimicrobial- resistant pathogens, including methicillin- resistant Staphylococcus aureus ( MRSA) and vancomycin-resistant enterococci ( VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial- resistant pathogens. ( 2) SHEA and APIC support the continued development, validation, and application of efficacious and cost- effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial- resistant and antimicrobial- susceptible pathogens. ( 3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare- associated infections. ( 4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost- effectiveness of using active surveillance cultures to screen both lower- risk and high- risk populations. ( 5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.