Importance of the environment in meticillin-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 meticillin-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.