Related Experiment Video
Updated: May 8, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with
D Fisher1, P A Tambyah, R T P Lin
1Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Infection Control Team, National University Health System, Singapore.
Background:
Meticillin-resistant Staphylococcus aureus (MRSA) has been entrenched in Singapore hospitals since the 1980s, with an excess of 600 non-duplicate cases of infections (120 bacteraemia episodes) each year in our 995-bed university hospital. Approximately 5% of our hospital beds are used as isolation facilities.
Aim:
To study the impact of an MRSA control bundle that was implemented via gradual geographic extension across hospital wards.
Methods:
The bundle included active surveillance on admission and transfer/discharge to identify ward-based acquisition of MRSA, isolation and cohorting of MRSA-infected patients, enhanced hand hygiene initiatives, and publicly displayed feedback of MRSA acquisition and hand hygiene compliance rates. Implementation was between October 2006 and June 2010 in order to provide lead-time for the incremental development of infrastructural capacity, and to develop an ethic of infection prevention among staff. Results were analysed via interrupted time-series analysis.
Findings:
MRSA infections fell midway through the implementation, with MRSA bacteraemia declining from 0.26 [95% confidence interval (CI): 0.18-0.34] cases per 1000 inpatient-days in the first quarter of 2004 to 0.11 (95% CI: 0.07-0.19) cases per 1000 inpatient-days in the first quarter of 2012. MRSA acquisition rates fell a year after the programme had been fully implemented, whereas hand hygiene compliance rose significantly from 47% (95% CI: 44-49) in the first quarter of 2009 to 69% (95% CI: 68-71) in the first quarter of 2012.
Conclusion:
Successful staged implementation of an MRSA bundle in a hyper-endemic setting is sustainable and represents a model that may be adapted for similar settings.
Insights
A hospital implemented a Meticillin-resistant Staphylococcus aureus (MRSA) control bundle, significantly reducing MRSA infections and bacteraemia. Hand hygiene compliance improved substantially, demonstrating a sustainable model for infection prevention in hyper-endemic settings.
Area of Science:
- Infectious Disease Epidemiology
- Hospital Infection Control
- Public Health
Background:
- Meticillin-resistant Staphylococcus aureus (MRSA) is endemic in Singapore hospitals, causing over 600 infections annually.
- A 995-bed university hospital utilized approximately 5% of beds for isolation facilities.
Purpose of the Study:
- To evaluate the impact of a phased MRSA control bundle implementation.
- To assess the bundle's effectiveness across hospital wards using gradual geographic extension.
Main Methods:
- Implemented a bundle including active surveillance, isolation, cohorting, enhanced hand hygiene, and public feedback.
- Utilized interrupted time-series analysis to evaluate results from October 2006 to June 2010.
Main Results:
- MRSA bacteraemia decreased from 0.26 to 0.11 cases per 1000 inpatient-days between 2004 and 2012.
- MRSA acquisition rates declined a year post-implementation; hand hygiene compliance rose from 47% to 69% between 2009 and 2012.
Conclusions:
- Staged implementation of the MRSA bundle is sustainable in hyper-endemic hospital settings.
- This model offers a transferable strategy for infection control in similar environments.
Related Concept Videos
01:25Clinical Significance of Antibiotic Resistance
01:29Staphylococcal Skin Infections
01:25Mechanism of Antibiotic Resistance in MRSA
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:29Methods for Controlling Microbial Growth
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies. Common...