Effects on nursing workload of different methicillin-resistant Staphylococcus aureus (MRSA) control strategies

Nursing staff workload may influence hospital-acquired staphylococcal transmission. Closure of wards to new admissions is used in some institutions as part of methicillin-resistant Staphylococcus aureus (MRSA) outbreak control, and we postulated that it worked by reducing staff workload, allowing more time for good infection control practices. We have used the GRASPCopyright workload system to compare nursing workload during six MRSA outbreaks. Two outbreaks occurred while an aggressive control policy ('old'; 1994-1995) was in place, with a low threshold for ward closure. Control measures had been relaxed before the later four outbreaks, with wards remaining fully or partially open unless MRSA transmission proved intractable ('new'; 1995-1996). To standardize the analysis we compared GRASP and epidemiological data for periods while MRSA transmission was occurring on each ward ('during'), and four week periods 'before' and 'after'. Closing wards to admissions reduces staff workload towards a quality environment, although the nursing requirements of remaining patient rises. Workload pressures may rise during outbreaks if wards are not closed quickly and fully, and patients are not transferred to specialist isolation facilities. Changes in nursing workload need to be assessed during comparative studies of outbreak control measures and the GRASP(c) system appears to be a sensitive way to measure these.