A prospective survey of current methicillin-resistant Staphylococcus aureus control measures

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is now endem ic in tertiary referral hospitals among the developed world. By prospective survey, the effect of two measures aimed to reduce the: spread of MRSA was determined. First, a surgical ward with persistently high levels of MRSA d etection was cleaned and renovated. Second, the medical records of all MRSA -colonized patients were electronically Ragged, facilitating immediate appl ication of control measures on readmission. Methods: Data were collected for 995 newly colonized patients admitted betw een 1 July 1995 and 31 December 1997. Methicillin- resistant Saphylococcus aureus detection was determined before and after implementation of the inte rventions, along with the likely place of MRSA acquisition and the monthly incidence of MRSA detection for all inpatients. Chi-squared testing with od ds ratios and 95% confidence intervals determined associations between the effect of control measures studied and MRSA detection rates. Results: New MRSA detection was 21.6 per 1000 admissions before refurbishme nt compared with 20.3 per 1000 admissions to the surgical ward after refurb ishment. New MRSA detection averaged 6.4 per 1000 hospital admissions befor e the introduction of record nagging and patient cohorting, compared with 6 .2 per 1000 admissions after. Conclusion: Neither ward refurbishment, nor introduction of nagging, signif icantly reduced rates of colonization during the study period. In hospitals that receive MRSA-colonized patients and provide intensive care facilities , spread of MRSA is a major problem. Effective containment demands separate wards for MRSA-colonized and non-colonized patients. The need for such con tainment should be considered in design of the modem hospital.