title: Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data.
abstract: Little is known about the amount of cross-transmission, the risk factors for infection, and the relative effectiveness of infection control procedures when methicillin-resistant Staphylococcus aureus (MRSA) infection occurs at highly endemic levels in intensive care units. A cohort study was done to identify exposures associated with cases that likely were the result of cross-transmission (i.e., occurring in clusters and with indistinguishable MRSA macrorestriction profiles). Fitting a simple stochastic model to the ascertained data allowed prediction of the effectiveness of infection control measures. Exposure to relative staff deficit (adjusted rate ratio, 1.05 independent; 95% confidence interval, 1.02-1.09) was the only factor significantly associated with potential transmission (P =.001). It was predicted that a 12% improvement in adherence to hand-hygiene policies might have compensated for staff shortage and prevented transmission during periods of overcrowding, shared care, and high workload but that this would be hard to achieve.
authors.affiliation: Division of Microbiology and Infectious Diseases, University Hospital Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom. Hajo.Grundmann@Nottingham.ac.uk
authors.forename: Hajo
authors.initials: H
authors.lastname: Grundmann
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hori
authors.forename: Bob
authors.initials: B
authors.lastname: Winter
authors.forename: Adriana
authors.initials: A
authors.lastname: Tami
authors.forename: Daren J
authors.initials: DJ
authors.lastname: Austin
mesh_terms: D016000:Cluster Analysis; D003428:Cross Infection / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007362:Intensive Care Units; D016106:Methicillin Resistance; D008954:Models, Biological; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects*