CLSI steps into the MRSA surveillance arena

The Clinical and Laboratory Standards Institute (CLSI) is “a global, nonprofit, standards-developing organization that promotes the development and use of voluntary consensus standards and guidelines within the health care community.” The guidance produced by CLSI is widely respected and adopted as a standard in clinical laboratories. I was interested to see that CLSI has now completed a document devoted almost solely to MRSA screening! See here for sample pages. The document was developed to “provide infection preventionists...with the latest information regarding the development and implementation of a successful MRSA surveillance program.”

Check out the author list on the third page, filled with experts in various aspects of MRSA detection and control.

Now ask yourself these two questions:

How many on the above list are (or have ever been) actual hospital epidemiologists or infection preventionists who do not have blatant conflicts of interest with the makers of rapid MRSA detection tests (e.g. research funding, honoraria, employee)?

I count two (Dr. Salgado, who trained under Barry Farr and is a longtime proponent of active MRSA screening, and Dr. Weber).

How many are employed by companies that produce rapid MRSA detection tests and therefore stand to reap millions from widespread MRSA screening?

I count four, including the Medical Director of Diagnostics at BD-GeneOhm, the Senior Director for Scientific Affairs at Cepheid, the Director of Government Affairs at Cepheid, and a product manager for BD-GeneOhm.

I look forward to reading the full document—I hope it is more balanced than the abstract, which flatly states that active surveillance + contact isolation reduces MRSA transmission (Really? Does it always? Is it necessary?).

ADDENDUM: I reread this post this morning, and realize it comes across perhaps more harshly than I intended. I believe CLSI is a great organization--I am a proud participant on their antifungal susceptibility testing subcommittee. I also understand the need to involve industry in the development of these standards, for several reasons. I further believe that a guide to implementation of an active surveillance program could be quite valuable. Heck, Mike and I wrote one a couple years ago, but didn't focus on the detailed lab issues the CLSI guidance does.

What I meant to convey in my post was the now-pervasive influence of industry in infection prevention. It is simply a fact that diagnostic companies stand to reap great profits from a move to “universal” MRSA screening. This inevitably leads to lobbying for legislative mandates, funding of speakers and “opinion leaders”, and representation on expert panels, etc. This isn’t new, the conflict of interest issue is pervasive in medicine.