Evaluating the Effectiveness of Contact Isolation in Preventing Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Infection

Abstract

ISSUE: Most hospitals follow the Centers for Disease Control and Prevention (CDC) recommendation in the Isolation guideline to implement contact precautions (CP) for patients with resistant organisms. Although our hospital has reported increased prevalence of methicillin-resistant Staphylococcus aureus (MRSA), there has been no associated increase in healthcare-acquired MRSA infections. Increasing MRSA prevalence rates coupled with low rates of healthcare-associated MRSA infection speak for an infection control program that works. There are a number of reasons for the success of the program. First, there has been consistent emphasis placed on hand hygiene in this hospital. Second, the use of alcohol-based hand antiseptics has been in place since their inception. And finally, all patient rooms are private rooms, with the exception of a handful of inpatient rehabilitation and psychiatric beds. Upon careful review of this history, and the recommendations made by CDC in their Isolation guideline, infection control practitioners (ICPs) at our hospital elected, as early as 1995, not to require CP for patients infected or colonized with MRSA, but instead to use standard precautions (SP). Recently, however, increasing pressure from medical staff and the community has prompted a change in practice, specifically to require CP for patients infected with MRSA. PROJECT: Implementation of CP for MRSA–infected or –colonized patients began with extensive inservice education for all healthcare workers. Over 70 inservices were conducted in this 250-bed acute care hospital. Inservices included a review of SP, hand hygiene, and proper procedures for implementing CP. After implementation, rates of healthcare-associated infections caused by MRSA in critical care patient populations were compared to rates in the same populations during 2001. RESULTS: There was no difference in the rates of healthcare-associated transmission of MRSA before and after initiating CP in this hospital setting. LESSONS LEARNED: In order to continue to be of value to healthcare facilities, ICPs need to administer infection control programs that are not only cost-effective but also science-based. Scarce healthcare dollars were wasted in our hospital on implementation of processes that made no difference in outcomes.