Single rooms, isolation wards, and nursing cohorts help to control MRSA colonisation and infection in hospitals

Abstract

QuestionDo isolation measures reduce the incidence of methicillin resistant Staphylococcus aureus (MRSA) infection in hospitalised people?Study designSystematic review.Main resultsForty-six studies met inclusion criteria (9 studied nursing cohorts, 18 studied isolation wards and 19 studied other isolation measures). There were no randomised controlled trials, 4 prospective comparison studies and 38 interrupted time-series. Forty-five studies used isolation measures that contained multiple interventions. Although in general, the interventions appeared to reduce MRSA infection rates, it was difficult to isolate effects of specific interventions. Furthermore, the studies could not rule out alternative explanations for reduced MRSA, for example, differences in antibiotic prescribing, staff workload, staff-to-patient ratio and length of hospital stay. Twenty-four interrupted time-series studies used inappropriate statistical analyses that did not allow for patient-to-patient MRSA transmission.Authors’ conclusionsThere are major methodological weaknesses in most of the studies examining the effectiveness of isolation measures in controlling MRSA colonisation and infection in hospitals. However, there is limited evidence that isolation methods involving the use of single rooms, isolation wards, and nursing cohorts, help to control MRSA outbreaks and reduce the number of MRSA infected patients. Better quality studies are needed if control of MRSA infection in hospitals is to be improved.