title: Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches.
abstract: BACKGROUND
  Current approaches in the control of methicillin-resistant Staphylococcus aureus (MRSA) in the large tertiary referral hospital have not been universally successful.
  
  
  METHODS
  The trend of MRSA rates and their relationship with stepwise implementation of preventive strategies in Tokai University Hospital during a 76-month period from September 1998 to December 2004, was retrospectively analyzed with a quasi-experimental design.
  
  
  RESULTS
  Implementation of strategies including a feedback process with case and epidemic reporting, an infection control team and office, and a preventive guideline for MRSA did not result in reduction in monthly MRSA rates in the hospital, as analyzed with Shewhart u charts. When infection control link nurses were organized and their activities became full-scale, there appeared significant reduction in arithmetic mean of the monthly rates of MRSA from 6.3% to 5.0% in June 2002. Meanwhile the mean values for monthly counts of new MRSA cases also dropped in 15 of 25 wards/units in June 2002, as analyzed with Exponentially Weighted Moving Average charts. Concurrently, there was a significant increase (17.3%) in the monthly consumption of handwashing liquid plain soap. Thereafter the MRSA rates remained low for 2 years within three standard deviations.
  
  
  CONCLUSIONS
  The sustained reduction of MRSA rates in the hospital can be related to introduction of the infection control link-nurse system on the basis of continuous enforcement of basic and multidisciplinary approaches such as hand-hygiene compliance.
authors.affiliation: Laboratory Medicine, Clinical Laboratory and Infection Control Office, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan. miyachi@is.icc.u-tokai.ac.jp
authors.forename: Hayato
authors.initials: H
authors.lastname: Miyachi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furuya
authors.forename: Kazuo
authors.initials: K
authors.lastname: Umezawa
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Itoh
authors.forename: Toshio
authors.initials: T
authors.lastname: Ohshima
authors.forename: Motoaki
authors.initials: M
authors.lastname: Miyamoto
authors.forename: Satomi
authors.initials: S
authors.lastname: Asai
mesh_terms: D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006235:Hand Disinfection / Q000379:methods; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000458:organization & administration*; D016106:Methicillin Resistance; D010564:Personnel, Hospital; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects*