Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units
To evaluate the effectiveness of screening strategy and contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA).
Design and setting
Prospective observational cohort from 1 February 1995 to 31 December 2001 in three intensive care units (45 beds) in a French teaching hospital.
8,548 patients admitted to the three ICUs had nasal screening on ICU admission and weekly thereafter. Contact precautions were used in MRSA-positive patients. The following variables were collected: age, gender, severity score, length of stay, workload, and colonization pressure (percentage of patient-days with an MRSA to the number of patient-days in the unit). Alcohol-based handrub solution was introduced in July 2000. We compared the period before this (P1) with that thereafter (P2).
Of the 8,548 admitted patients 554 (6.5%) had MRSA at ICU admission, and 456 of the 7,515 (6.1%) exposed patients acquired MRSA. Acquisition incidence decreased from 7.0% in P1 to 2.8% in P2. Independent variables associated with MRSA acquisition were: age (adjusted odds ratio 1.013), severity score (1.047), length of ICU stay (1.015), colonization pressure (1.019), medical ICU (1.58), and P2 (0.49).
MRSA control in these ICUs characterized by a high prevalence of MRSA at admission was achieved via multiple factors, including screening, contact precautions, and use of alcoholic handrub solution. Our results after adjustment of risk factors for MRSA acquisition and the steady improvement in MRSA over several years strengthen these findings. MRSA spreading can be successfully controlled in ICUs with high colonization pressure.
KeywordsStaphylococcus aureus Methicillin resistance Intensive care units Prevention and control
- 1.Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, Beach M (2001) Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis 32:S114–S132CrossRefPubMedGoogle Scholar
- 14.Scanvic A, Denic L, Gaillon S, Giry P, Andremont A, Lucet JC (2001) Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 32:1393–1398Google Scholar
- 18.Rigaud MP, Deblangy C, Fargeot C, Descamps V, Abiteboul D, Lolom I, Andremont A, Bouvet E, Lucet JC (2002) Evaluation de la tolérance cutanée d’une solution hydro-alcoolique. HygièneS 10:11–15Google Scholar
- 21.Cepeda JA, Whitehouse T, Cooper B, Hails J, Jones K, Kwaku F, Taylor L, Hayman S, Cookson B, Shaw S, Kibbler C, Singer M, Bellingan G, Wilson AP (2005) Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 365:295–304PubMedGoogle Scholar
- 22.Nijssen S, Bonten MJ, Weinstein RA (2005) Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis 40:405–409Google Scholar
- 29.Société de réanimation de langue française (2002) Recommandations des experts de la Société de réanimation de langue française, janvier 2002: prévention de la transmission croisée en réanimation. Réanimation Soins Intensifs Med Urgence 11:250–256Google Scholar