title: Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study.
abstract: BACKGROUND
  Hospital-acquired infection due to meticillin-resistant Staphylococcus aureus (MRSA) is common within intensive-care units. Single room or cohort isolation of infected or colonised patients is used to reduce spread, but its benefit over and above other contact precautions is not known. We aimed to assess the effectiveness of moving versus not moving infected or colonised patients in intensive-care units to prevent transmission of MRSA.
  
  
  METHODS
  We undertook a prospective 1-year study in the intensive-care units of two teaching hospitals. Admission and weekly screens were used to ascertain the incidence of MRSA colonisation. In the middle 6 months, MRSA-positive patients were not moved to a single room or cohort nursed unless they were carrying other multiresistant or notifiable pathogens. Standard precautions were practised throughout. Hand hygiene was encouraged and compliance audited.
  
  
  RESULTS
  Patients' characteristics and MRSA acquisition rates were similar in the periods when patients were moved and not moved. The crude (unadjusted) Cox proportional-hazards model showed no evidence of increased transmission during the non-move phase (0.73 [95% CI 0.49-1.10], p=0.94 one-sided). There were no changes in transmission of any particular strain of MRSA nor in handwashing frequency between management phases.
  
  
  CONCLUSIONS
  Moving MRSA-positive patients into single rooms or cohorted bays does not reduce crossinfection. Because transfer and isolation of critically ill patients in single rooms carries potential risks, our findings suggest that re-evaluation of isolation policies is required in intensive-care units where MRSA is endemic, and that more effective means of preventing spread of MRSA in such settings need to be found.
authors.affiliation: Department of Clinical Microbiology, University College London Hospitals, London W1T 4 JF, UK.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Cepeda
authors.forename: Tony
authors.initials: T
authors.lastname: Whitehouse
authors.forename: Ben
authors.initials: B
authors.lastname: Cooper
authors.forename: Janeane
authors.initials: J
authors.lastname: Hails
authors.forename: Karen
authors.initials: K
authors.lastname: Jones
authors.forename: Felicia
authors.initials: F
authors.lastname: Kwaku
authors.forename: Lee
authors.initials: L
authors.lastname: Taylor
authors.forename: Samantha
authors.initials: S
authors.lastname: Hayman
authors.forename: Barry
authors.initials: B
authors.lastname: Cookson
authors.forename: Steve
authors.initials: S
authors.lastname: Shaw
authors.forename: Chris
authors.initials: C
authors.lastname: Kibbler
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bellingan
authors.forename: A Peter R
authors.initials: AP
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010356:Patient Isolation; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects*; D014187:Transportation of Patients