Comparison of control strategies for methicillin-resistant Staphylococcus aureus

Screening patients for methicillin-resistant Staphylococcus aureus (MRSA) colonization and contact precautions for colonized patients has been recommended when other control measures have been ineffective.

We compared MRSA transmission rates following implementation of a bundle of control measures that included institutional culture change, surveillance for MRSA infection and transmission, and active screening for colonization in 2 similar Veterans Health Administration hospitals. One hospital employed contact precautions as defined by the Centers for Disease Control and Prevention, and the other hospital modified contact precautions, requiring only the use of gloves.

During the 4-year study period, there were 1.58 MRSA transmissions per 1,000 patient-days at hospital A and 1.56 MRSA transmissions per 1,000 patient-days at hospital B (P = .98). Both hospitals experienced significant reductions in MRSA health care-associated infections (HAI). There was no difference between hospital A and hospital B in incidence of MRSA HAIs or MRSA surgical site infections. Annual acquisition costs for cover gowns were $183,609 at hospital A and $25,812 at hospital B.

Significant reductions in MRSA HAI were associated with implementation of the MRSA control bundle. The bundle that included full contact precautions for colonized patients was no more effective in prevention of MRSA transmissions than a similar bundle that omitted the use of cover gowns.