Sustained reduction in the clinical incidence of methicillin-resistant Staphylococcus aureus colonization or infection associated with a multifaceted infection control intervention.
OBJECTIVE
To assess the impact and sustainability of a multifaceted intervention to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission implemented in 3 chronologically overlapping phases at 1 hospital.


METHODS
Interrupted time-series analyses.


METHODS
A Veterans Affairs hospital in the northeastern United States.


METHODS
Individuals admitted to acute care units from October 1, 1999, through September 30, 2008. To calculate the monthly clinical incidence of MRSA colonization or infection, the number of MRSA-positive cultures obtained from a clinical site more than 48 hours after admission among patients with no MRSA-positive clinical cultures during the previous year was divided by patient-days at risk. Secondary outcomes included clinical incidence of methicillin-sensitive S. aureus colonization or infection and incidence of MRSA bloodstream infections.


METHODS
The intervention--implemented in a surgical ward beginning October 2001, in a surgical intensive care unit beginning October 2003, and in all acute care units beginning July 2005--included systems and behavior change strategies to increase adherence to infection control precautions (eg, hand hygiene and active surveillance culturing for MRSA).


RESULTS
Hospital-wide, the clinical incidence of MRSA colonization or infection decreased after initiation of the intervention in 2001, compared with the period before intervention (P = .002), and decreased by 61% (P < .001) in the 7-year postintervention period. In the postintervention period, the hospital-wide incidence of MRSA bloodstream infection decreased by 50% (P = .02), and the proportion of S. aureus isolates that were methicillin resistant decreased by 30% (P < .001).


CONCLUSIONS
Sustained decreases in hospital-wide clinical incidence of MRSA colonization or infection, incidence of MRSA bloodstream infection, and proportion of S. aureus isolates resistant to methicillin followed implementation of a multifaceted prevention program at one Veterans Affairs hospital. Findings suggest that interventions designed to prevent transmission can impact endemic antimicrobial resistance problems.
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. kellingson@cdc.gov
Katherine
K
Ellingson
Robert R
RR
Muder
Rajiv
R
Jain
David
D
Kleinbaum
Pei-Jean I
PJ
Feng
Candace
C
Cunningham
Cheryl
C
Squier
Jon
J
Lloyd
Jonathan
J
Edwards
Val
V
Gebski
John
J
Jernigan
D003140:Communicable Disease Control / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D006787:Hospitals, Veterans; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010414:Pennsylvania / Q000453:epidemiology; D015397:Program Evaluation; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*