Relationship between the prevalence of methicillin-resistant Staphylococcus aureus infection and indicators of nosocomial infection control measures: a population-based study in French hospitals.
OBJECTIVE
To assess whether infection control indicators are associated with the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in French hospitals.


METHODS
We linked the database for the 2006 national prevalence survey of nosocomial infection with the database of infection control indicators (comprised of ICALIN, an indicator of infection control organization, resources, and action, and ICSHA, an indicator of alcohol-based handrub consumption) recorded from hospitals by the Ministry of Health. Data on MRSA infection were obtained from the national prevalence survey database and included the site and origin of infection, the microorganism responsible, and its drug resistance profile. Because the prevalence of MRSA infection was low and often nil, especially in small hospitals, we restricted our analysis to hospitals with at least 300 patients. We used a multilevel logistic regression model to assess the joint effects of patient-level variables (eg, age, sex, or infection) and hospital-level variables (infection control indicators).


RESULTS
Two hundred two hospitals had at least 300 patients, for a total of 128,631 patients. The overall prevalence of MRSA infection was 0.34% (95% confidence interval [CI], 0.29%-0.39%). The mean value for ICSHA was 7.8 L per 1,000 patient-days (median, 6.1 L per 1,000 patient-days; range, 0-33 L per 1,000 patient-days). The mean value for ICALIN was 92 of a possible 100 points (median, 94.5; range, 67-100). Multilevel analyses showed that ICALIN scores were associated with the prevalence of MRSA infection (odds ratio for a score change of 1 standard deviation, 0.80; 95% CI, 0.69-0.93). We found no association between prevalence of MRSA infection and ICSHA. Other variables significantly associated with the prevalence of MRSA infection were sex, vascular or urinary catheter, previous surgery, and the McCabe score.


CONCLUSIONS
We found a significant association between the prevalence of MRSA infection and ICALIN that suggested that a higher ICALIN score may be predictive of a lower prevalence of MRSA infection.
Grammatico-Guillon
Leslie
L
Institut de Veille Sanitaire, University Hospital, Tours, France. lilou_g1334@yahoo.fr
Thiolet
Jean-Michel
JM
Bernillon
Pascale
P
Coignard
Bruno
B
Khoshnood
Babak
B
Desenclos
Jean-Claude
JC
D000368:Aged; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005602:France / Q000453:epidemiology; D006235:Hand Disinfection / Q000379:methods / Q000592:standards; D006769:Hospitals, General; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008875:Middle Aged; D055361:Multilevel Analysis; D015995:Prevalence; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control