title: Pre-emptive contact precautions for intubated patients reduced healthcare-associated meticillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit.
abstract: Healthcare-associated infection by meticillin-resistant Staphylococcus aureus (MRSA) is still a great concern in an intensive care unit (ICU). Our surveillance data in the ICU revealed that intubated patients were at eight times higher risk of acquiring MRSA than non-intubated patients, so we hypothesised that pre-emptive contact precautions for all intubated patients would prevent healthcare-associated infection by MRSA in the ICU. Patients staying in our ICU for >2 days were included in this study. The study period was divided into two periods. During 2004 (1st period), contact precautions were performed only for patients with MRSA. During 2005-2007 (2nd period), contact precautions were applied to all intubated patients regardless of MRSA infection status. Patients were defined as MRSA-positive on admission when MRSA was detected by surveillance or clinical culture on enrolment. Other MRSA-positive results were defined as healthcare-associated MRSA (HA-MRSA) transmission. HA-MRSA infection was diagnosed according to the National Nosocomial Infections Surveillance Manual. The 1st period comprised 415 patients, and the 2nd period comprised 1280 patients. In intubated patients, HA-MRSA infection rate decreased significantly in the 2nd period (1st period 12.2%, 2nd period 5.6%; P=0.015). HA-MRSA infection of all patients decreased from 3.6 to 2.3 incidents per 1000 patient-days (P<0.05), despite a significant increase in the rate of patients MRSA positive on admission in the 2nd period (1st period 2.9%; 2nd period 6.1%). Pre-emptive contact precautions for intubated patients would be helpful in reducing HA-MRSA infection in ICU.
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. asakouab@yahoo.co.jp
authors.forename: A
authors.initials: A
authors.lastname: Matsushima
authors.forename: O
authors.initials: O
authors.lastname: Tasaki
authors.forename: K
authors.initials: K
authors.lastname: Tomono
authors.forename: H
authors.initials: H
authors.lastname: Ogura
authors.forename: Y
authors.initials: Y
authors.lastname: Kuwagata
authors.forename: H
authors.initials: H
authors.lastname: Sugimoto
authors.forename: T
authors.initials: T
authors.lastname: Hamasaki
mesh_terms: D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D016635:Universal Precautions / Q000191:economics* / Q000379:methods