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Updated: Mar 14, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Estimating Changes in Facility Methicillin-Resistant Staphylococcus aureus (MRSA) Infection Rates Due to Changes in
Karim Khader1,2, Candace Haroldsen1,2, Vanessa Stevens1,2
1Informatics, Decision Enhancement, and Analytical Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Background:
The effectiveness of contact precautions (CP) and active surveillance (AS) for preventing methicillin-resistant Staphylococcus aureus (MRSA) in acute care remains uncertain. Some studies suggest CP reduces MRSA spread, while others report limited benefit. The COVID-19 pandemic disrupted MRSA prevention practices in the VA, creating an opportunity to assess their impact on MRSA healthcare-associated infections (HAIs).
Methods:
We studied 121 VA acute care hospitals from July 2020-June 2022. Facility practices (AS, CP for colonized [CPC], CP for infected [CPI]) were assessed via national surveys. Patient-level data identified MRSA HAIs (incident cultures ≥3 days postadmission). Secondary outcomes included sterile-site infections and 30-day postdischarge cultures. Associations between practices and HAI rates were estimated using Poisson, negative binomial, and mixed-effects Poisson regression, adjusting for baseline MRSA burden, COVID-19 admissions, culturing intensity, and hospital characteristics.
Results:
Among 905 164 admissions, 1708 incident MRSA cultures were identified. Many facilities suspended at least one prevention practice early in the pandemic, though most later reinstated them. In simpler models, discontinuation of AS, CPC, or CPI was associated with higher MRSA rates, but these associations were attenuated after adjustment for baseline burden. Mixed-effects models found no significant associations, and results were consistent across secondary outcomes.
Conclusions:
Discontinuation of MRSA prevention practices during the pandemic was not consistently linked to increased HAIs after accounting for baseline burden. Findings emphasize the role of facility-specific factors and modeling assumptions in evaluating infection control. Unmeasured pandemic-related practices (eg, masking, PPE use) likely also influenced transmission, highlighting the need for flexible, context-sensitive, evidence-based infection prevention policies.
Insights
Contact precautions (CP) and active surveillance (AS) for methicillin-resistant Staphylococcus aureus (MRSA) effectiveness in preventing healthcare-associated infections (HAIs) remains unclear. Pandemic disruptions did not consistently link practice changes to increased MRSA HAIs after adjusting for baseline burden.
Area of Science:
- Infection Prevention and Control
- Healthcare Epidemiology
- Antimicrobial Resistance
Background:
- The effectiveness of contact precautions (CP) and active surveillance (AS) for preventing methicillin-resistant Staphylococcus aureus (MRSA) in acute care settings is uncertain.
- Some studies indicate CP reduces MRSA spread, while others show limited benefit.
- The COVID-19 pandemic disrupted standard MRSA prevention practices, offering a unique opportunity to evaluate their impact on MRSA healthcare-associated infections (HAIs).
Purpose of the Study:
- To assess the impact of changes in MRSA prevention practices (AS, CP for colonized, CP for infected) on MRSA HAIs during the COVID-19 pandemic.
- To evaluate the association between the discontinuation and reinstatement of these practices and MRSA HAI rates in Veterans Affairs (VA) acute care hospitals.
Main Methods:
- A study of 121 VA acute care hospitals from July 2020 to June 2022.
- Facility practices were assessed via national surveys, and patient-level data identified MRSA HAIs.
- Statistical models (Poisson, negative binomial, mixed-effects Poisson regression) were used to estimate associations, adjusting for baseline MRSA burden and other factors.
Main Results:
- Among 905,164 admissions, 1,708 incident MRSA HAIs were identified.
- Many facilities temporarily suspended prevention practices but later reinstated them.
- While simpler models suggested higher MRSA rates upon discontinuation, these associations were not significant in adjusted mixed-effects models.
Conclusions:
- Discontinuation of MRSA prevention practices during the pandemic was not consistently associated with increased HAIs when baseline burden was considered.
- Findings highlight the importance of facility-specific factors and modeling assumptions in infection control evaluations.
- Unmeasured pandemic-related practices likely influenced transmission, emphasizing the need for flexible, evidence-based infection prevention policies.
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