Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning


In the UK, we continue to debate the importance of hospital cleaning in relation to increasing numbers of patients acquiring methicillin-resistant Staphylococcus aureus (MRSA). However, there is little direct evidence for the effectiveness of cleaning because it has never been afforded scientific status. Hospital hygiene is usually assessed visually, but this does not necessarily correlate with microbiological risk. A more robust case for hospital cleaning can be presented by considering the evidence for all the stages of the staphylococcal transmission cycle between human beings and their environment. Cleaning has already been accepted as an important factor in the control of other hardy environmental pathogens, such as Clostridium difficile, vancomycin-resistant enterococci, norovirus, and Acinetobacter spp. This Review will show why the removal of dirt might have more impact on the control of MRSA than previously thought. Introduction of additional cleaning services is easier than improvements in hand-hygiene compliance.


Note: The complete article is available from Lancet Infectious Diseases.

Formerly a consultant microbiologist at the Southern General Hospital in Glasgow, Scotland (2005-7), Stephanie now works in NHS Lanarkshire and is the current editor of the Journal of Hospital Infection. She trained at St. Bartholomew's hospital in London (1977-83) followed by postgraduate studies in Pathology at Guy's hospital, where she produced a thesis on the epidemiology and biochemistry of toxin-producing staphylococci. She has worked in various remote areas of the world, including Papua New Guinea, Thailand, Vietnam and the Canadian High Arctic, where she resuscitated 30,000 year old organisms from glacial ice. She spent six years as the Infection Control Officer for Argyll before moving to Health Protection Scotland as their inaugural microbiologist (2002-5). There she set up MRSA surveillance for Scotland, evaluated real-time PCR for the rapid identification of MRSA and helped establish the Scottish Microbiology Forum. She has been an active member of several national working groups on antibiotic prescribing and hospital cleaning, and was a formal referee for the Scottish Health Technology Assessment on MRSA screening. At present she balances clinical and editorial duties with various research projects, specifically the role of antibiotics, screening and cleaning in the control of MRSA.


Dr. Stephanie J. Dancer

Department of Microbiology
Hairmyres Hospital,

Eaglesham Road, East Kilbride G75 8RG, UK.

Tel +44 (0)1355 585000

[email protected]