Reduction of nosocomial acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in a community hospital through adherence to standard precautions

Abstract

BACKGROUND/OBJECTIVES: The number of patients culture-positive for methicillin-resistant Staphylococcus aureus (MRSA) at a 235-bed community acute care hospital had been slowly increasing since data were first collected. According to policy, MRSA-positive patients were placed in contact precautions. In 2002 the infection control committee changed this policy as it appeared to have little or no effect on the incidence of nosocomial spread but had a negative impact on patient care. The new policy eliminated use of contact precautions; instead only standard precautions would be followed on MRSA patients. The Centers for Disease Control and Prevention (CDC) state that standard precautions “should control the spread of MRSA in most instances” but that “if MRSA is judged by the hospital's infection control program to be of special clinical or epidemiologic significance, then contact precautions should be considered.” Prior to the policy change, there was an average of 10 nosocomial cases of MRSA/month (1.61/1000 patient days). Following the elimination of contact precautions, the incidence of nosocomial MRSA decreased and has sustained. The average number of nosocomial cases of MRSA 2 years later was METHODS: Prior to implementing the policy, the infection control practitioner (ICP) met with medical staff committees to discuss the proposed change and its rationale, to educate physicians, and to gain their support. There was mixed support, but ultimately the policy change was accepted. The ICP implemented an educational program for all staff focusing on three things: MRSA and its transmission; the prevalence of MRSA at the facility and incidence of nosocomial spread; and the fundamentals of standard precautions, emphasizing the importance of strict adherence with all patients. Educational efforts focused on a paradigm shift whereby prevention of transmission through standard precautions rather than reliance on patient isolation was emphasized. RESULTS: Nosocomial MRSA significantly decreased following discontinuation of contact precautions. The rate went from 9.67 cases/mo to 4.33 cases/mo. Patient care was positively impacted. CONCLUSIONS: Educational interventions which focused on adherence to standard precautions resulted in improved quality of patient care and decreased nosocomial MRSA. Education of staff proved to be far more important in decreasing nosocomial spread than did initiating contact precautions.