Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus

Observational and microbiological data were collected from the patients and environment of a male general surgical ward over a period of 27 months fro m January 1998. Isolates of methicillin-resistant Staphylococcus aureus (MR SA) from patients and environment were typed by antibiogram, bacteriophage and pulsed field gel electrophoresis of chromosomal DNA. In September 1999, an intervention was put in place which included increasing the domestic cl eaning time by 57 hours per week, with emphasis on removal of dust by vacuu m cleaning, and allocation of responsibility for the routine cleaning of sh ared medical equipment. From January 1998 to September 1999, despite standard infection control mea sures (emphasis on hand hygiene, isolation of affected patients and stagger ed closure and cleaning of ward bays), 69 patients acquired a strain of E-M RSA16. This strain was also widespread in the ward environment. Typing conf irmed that isolates from patients and environment were indistinguishable fr om one another and that the outbreak was due to a single strain. This strai n,vas responsible for postoperative infection in approximately one third of the patients who acquired it. In the six months following the intervention , only three patients were colonized with the outbreak MRSA and monthly sur veys failed to detect this strain in the environment. Thorough and continuo us attention to ward hygiene and removal of dust was needed, to terminate a prolonged outbreak of MRSA infection on a general surgical ward, in additi on to standard infection control measures. Control of hospital-acquired inf ection with MRSA requires a combination of measures, none of which are comp letely effective in isolation. (C) 2001 The Hospital Infection Society.