A CONTROL PROGRAM FOR MRSA (METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS) CONTAINMENT IN A PEDIATRIC INTENSIVE-CARE UNIT - EVALUATION AND IMPACT ON INFECTIONS CAUSED BY OTHER MICROORGANISMS

Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly rep orted as a hospital-acquired pathogen in intensive care units (ICUs). The inconsistent application of hygiene measures by healthcare workers accounts largely for the epidemic dissemination of such resistant str ains. The efficacy of a control programme to prevent spread of MRSA wa s assessed in our paediatric ICU (PICU) from April 1992 to December 19 95. Patients initially had weekly MRSA cultures taken from samples of anterior nares and perineum, but from January 1994, cultures were also obtained upon admission. Immediately after notification, all MRSA car riers were isolated. Education of hospital staff was an essential comp onent of our programme. Nosocomial infection rates were recorded retro spectively in 1992 and 1993, and prospectively in 1994 and 1995. Incid ence rates between 'pre-programme' and 'programme' periods were compar ed. The rate of MRSA infection decreased from 5.9-0.8/1000 Patient-Day s (PD), (P<10(-7)). MRSA carriage also decreased from 34-2% (P<10(-9)) and the ratio of MRSA to all S. aureus fell from 71-11% (P<10(-4)). T he decrease in the global incidence of infection from 20.1-13.9/1000 P D (P=0.002) was due only to the decrease in MRSA infection. However, b etween 1994 and 1995, there was a significant increase in the number o f transplant patients despite a constant patient/nurse ratio. The noso comial infection rates caused by other micro-organisms decreased among the transplant patients from 64.8-33.2/1000 transplanted PD (P=0.009) between 1994 and 1995. At the same time, we observed a slight increas e of infections in non-transplanted patients, which may have been due to the effect of increased overall workload on those patients who were supposed to have fewer nosocomial risk factors. We conclude that impl ementation of infection control measures directed towards limiting per son-to-person spread was effective in controlling high MRSA infection rates in a PICU, but it is important to allow enough time for staff to carry out hygiene practices thoroughly.