Implementation of an intensified infection control program to reduce MRSA transmissions in a German tertiary care hospital

Abstract

Germany has witnessed increasing national methicillin-resistant Staphylococcus aureus (MRSA) rates during the past 2 decades. In our 900-bed tertiary care community hospital, a similar increase was noted during the period from 1994 to 2002, although single-room isolation and decolonization therapy were the standard of care. An intensified infection control program aimed at the reduction of nosocomial MRSA transmissions was developed in 2002 and translated into clinical practice in 2003. Essential components of the program were a detailed written MRSA standard, acquisition of signal-colored isolation gowns and storage carts facilitating the use of separate supplies for MRSA patients, intensified surveillance and feedback of MRSA data, "flagging" of formerly positive MRSA patients, and a general MRSA screening policy for all newly admitted patients on the surgical intensive care unit (ICU). The effect of the program was monitored by continuous surveillance of MRSA cases on all wards. The transmission index was defined as the ratio between secondary and "imported" MRSA cases. Comparing the preintervention (2002) and postintervention (2005-2006) periods, the total number of MRSA patients, MRSA rates on the ICUs, and invasive MRSA infections on the ICUs were reduced. The MRSA transmission index fell from 2.1 (2002) to 0.8 (2006). The rate of deep incisional and organ/space infections due to MRSA occurring after orthopedic surgery was lowered from 0.74 to 0.15%. Our data indicate that the efficacy of single-room isolation and decolonization therapy can be strongly enhanced by means of a multicomponent, comprehensive MRSA control program. The program was effective despite an increasing "import" of new MRSA cases. Programs of this type may be suited to achieve a downward turn of MRSA figures in Germany.