A prospective survey of current methicillin-resistant Staphylococcus aureus control measures.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) is now endemic in tertiary referral hospitals among the developed world. By prospective survey, the effect of two measures aimed to reduce the spread of MRSA was determined. First, a surgical ward with persistently high levels of MRSA detection was cleaned and renovated. Second, the medical records of all MRSA-colonized patients were electronically flagged, facilitating immediate application of control measures on readmission.


METHODS
Data were collected for 995 newly colonized patients admitted between 1 July 1995 and 31 December 1997. Methicillin-resistant Staphylococcus aureus detection was determined before and after implementation of the interventions, along with the likely place of MRSA acquisition and the monthly incidence of MRSA detection for all inpatients. Chi-squared testing with odds ratios and 95% confidence intervals determined associations between the effect of control measures studied and MRSA detection rates.


RESULTS
New MRSA detection was 21.6 per 1000 admissions before refurbishment compared with 20.4 per 1000 admissions to the surgical ward after refurbishment. New MRSA detection averaged 6.4 per 1000 hospital admissions before the introduction of record flagging and patient cohorting, compared with 6.2 per 1000 admissions after.


CONCLUSIONS
Neither ward refurbishment, nor introduction of flagging, significantly reduced rates of colonization during the study period. In hospitals that receive MRSA-colonized patients and provide intensive care facilities, spread of MRSA is a major problem. Effective containment demands separate wards for MRSA-colonized and non-colonized patients. The need for such containment should be considered in design of the modern hospital.
Barakate
M S
MS
University of Sydney, Division of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. msbarakate@hotmail.com
Harris
J P
JP
West
R H
RH
Vickery
A M
AM
Sharp
C A
CA
Macleod
C
C
Benn
R A
RA
D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D004203:Disinfection; D019353:Endemic Diseases; D006749:Hospital Design and Construction; D006801:Humans; D015994:Incidence; D017053:Infection Control; D008499:Medical Records; D016106:Methicillin Resistance; D009517:New South Wales; D016017:Odds Ratio; D010343:Patient Admission; D010356:Patient Isolation; D010359:Patient Readmission; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control* / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects*; D013503:Surgery Department, Hospital