Virginia Department of Health, Office of Epidemiology
October 26, 2007
On October 24, 2007 an emergency regulation was enacted to require laboratory reporting of methicillin-resistant Staphylococcus aureus (MRSA) infections in normally sterile sites to the health department. The regulation will assist the Virginia Department of Health in tracking the occurrence and trends over time of the most serious forms of MRSA infection.
Specifically, the regulation is an amendment to the Regulations for Disease Reporting and Control. Section 12VAC5-90-80, paragraph B, pertaining to the list of conditions that must be reported by laboratory directors, was amended to add MRSA. The language in the regulation is as follows:
Staphylococcus aureus infection, resistant, as defined below.
A normally sterile site is defined as blood, cerebrospinal fluid, amniotic fluid, pleural fluid, peritoneal fluid, pericardial fluid, bone and bone marrow, joint fluid, and certain internal body sites (i.e., specimens obtained from surgery or aspirates). Urine, wounds, and sputum will not be considered sterile sites for purposes of this surveillance.
Methicillin-resistant is defined as an oxacillin MIC test on an S. aureus isolate with MIC > 4 ug/ml, an oxacillin disk diffusion test on an S. aureus isolate with a result of < 10 mm, or a cefoxitin disk diffusion test on an S. aureus isolate with a result of < 21 mm.
The reporting requirement applies to laboratories processing human clinical specimens for diagnostic purposes. These laboratories already report dozens of different diseases to the health department. As with all reporting, MRSA reports should be submitted to the local health department on a form used by the laboratory, which may include an Epi-1 form, a printout, or other form in use by the laboratory. Reports should be submitted within 3 days of confirmation.
The emergency regulation will be in effect for one year, during which time the Administrative Process will be followed to make the change permanent. The Administrative Process will allow for a 60-day public comment period.
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