Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units

Area of Science:

• Infectious Disease Epidemiology
• Hospital Infection Control
• Public Health

Background:

• Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings, particularly intensive care units (ICUs).
• High prevalence of MRSA at admission necessitates robust control strategies to prevent patient-to-patient transmission.
• Effective screening and isolation protocols are crucial for managing MRSA within hospital environments.

Purpose of the Study:

• To evaluate the effectiveness of a screening strategy combined with contact precautions for MRSA control.
• To assess the impact of introducing alcohol-based handrub solution on MRSA acquisition rates.
• To identify risk factors associated with MRSA acquisition in the ICU setting.

Main Methods:

• A prospective observational cohort study was conducted in three French ICUs from 1995 to 2001.
• Nasal screening for MRSA was performed on ICU admission and weekly thereafter for 8,548 patients.
• Contact precautions were implemented for MRSA-positive patients, with alcohol-based handrub introduced in July 2000 to compare pre- and post-intervention periods.

Main Results:

• MRSA acquisition incidence decreased significantly from 7.0% before alcohol-based handrub to 2.8% after its introduction.
• Independent risk factors for MRSA acquisition included older age, higher severity scores, longer ICU stays, and higher colonization pressure.
• The study identified medical ICUs as having a higher risk of MRSA acquisition.

Conclusions:

• A multifaceted approach including MRSA screening, contact precautions, and alcohol-based handrub effectively controls MRSA in ICUs.
• These interventions are particularly successful in ICUs with high MRSA colonization pressure at admission.
• Sustained efforts and risk factor management are key to achieving long-term MRSA control in critical care settings.