In Reply: Dr Harris raises an important point for US hospitals. However, incentives for hospitals differ, and our institution's decision to invest in screening was not driven by a desire to protect reimbursement from Swiss insurance companies, but rather an attempt to improve patient safety and reduce the overall cost burden of MRSA.
The letters by Dr Salgado and colleagues and Drs Jarvis and Muto raise methodological limitations that were discussed in our study. In contrast to the simultaneously published time-series analysis by Robicsek et al,1 our study focused on screening of patients in surgical wards and was performed in a setting with low MRSA infection rates, a preexisting screening and decolonization policy for known carriers, and compliance with hand hygiene recommendations markedly above usual standards,2 thus making it less likely to observe an added effect of general screening. Similar to our findings, a recent cluster-randomized crossover trial from the United Kingdom comparing rapid MRSA screening with conventional cultures did not observe a significant reduction of MRSA acquisition in geriatric, oncologic, and surgical wards and did not recommend universal rapid screening for MRSA carriage on admission to general wards.3 In support of this conclusion, there has been an unprecedented decline in endemic MRSA infections in several European countries and stable, relatively low rates in others without necessarily implementing universal screening policies.4