Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Home
  • Home
EnglishFrançais
Infection Control & Hospital Epidemiology Infection Control & Hospital Epidemiology

Article contents

Do Infection Control Measures Work for Methicillin-Resistant Staphylococcus aureus?

Published online by Cambridge University Press:  02 January 2015

John M. Boyce ,
Nancy L. Havill ,
Cynthia Kohan ,
Diane G. Dumigan  and
Catherine E. Ligi
John M. Boyce
Affiliation:
Department of Medicine, Hospital of Saint Raphael, New Haven, Connecticut
Nancy L. Havill
Affiliation:
Department of Medicine, Hospital of Saint Raphael, New Haven, Connecticut
Cynthia Kohan
Affiliation:
Department of Medicine, Hospital of Saint Raphael, New Haven, Connecticut
Diane G. Dumigan
Affiliation:
Department of Medicine, Hospital of Saint Raphael, New Haven, Connecticut
Catherine E. Ligi
Affiliation:
Department of Medicine, Hospital of Saint Raphael, New Haven, Connecticut
Get access
Rights & Permissions[Opens in a new window]

Abstract

Objective:

To review evidence regarding the effectiveness of control measures in reducing transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals.

Design:

Literature review and surveillance cultures of hospitalized patients at high risk for MRSA colonization or infection.

Setting:

A 500-bed, university-affiliated, community teaching hospital.

Results:

The percentage of nosocomial S. aureus infections caused by MRSA increased significantly between 1982 and 2002, despite the use of various isolation and barrier precaution policies. The apparent ineffectiveness of control measures may be due to several factors including the failure to identify patients colonized with MRSA For example, cultures of stool specimens submitted for Clostridium difficile toxin assays at one hospital found that 12% of patients had MRSA in their stool, and 41% of patients with unrecognized colonization were cared for without using barrier precautions. Other factors include the use of barrier precaution strategies that do not account for multiple reservoirs of MRSA, poor adherence of healthcare workers (HCWs) to recommended barrier precautions and handwashing, failure to identify and treat HCWs responsible for transmitting MRSA, and importation of MRSA by patients admitted from other facilities. Control programs that include active surveillance cultures (ASCs) of high-risk patients and use of barrier precautions have reduced MRSA prevalence rates and have been cost-effective. Using a staged approach to implementing ASCs can minimize logistic problems.

Conclusion:

MRSA control programs are effective if they include ASCs of high-risk patients, use of barrier precautions when caring for colonized or infected patients, hand hygiene, and treating HCWs implicated in MRSA transmission.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 5 , May 2004 , pp. 395 - 401
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below.
If you should have access and can't see this content please contact technical support.

References

1.Haley, RW, Hightower, AW, Khabbaz, RF, et al.The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals: possible role of the house staff-patient transfer circuit. Ann Intern Med 1982;97:297–308.CrossRefGoogle ScholarPubMed
2.Boyce, JM. Methicillin-resistant Staphylococcus aureus: detection, epidemiology, and control measures. Infect Dis Clin North Am 1989;3:901–913.Google ScholarPubMed
3.Murray-Leisure, KA, Geib, S, Graceley, D, et al.Control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 1990;11:343–350.CrossRefGoogle Scholar
4.Reboli, AC, John, JF Jr, Levkoff, AH. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit. American Journal of Diseases of Children 1989;143:34–39.Google Scholar
5.Rao, N, Jacobs, S, Joyce, L. Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hosp Epidemiol 1988;9:255–260.CrossRefGoogle Scholar
6.Panlilio, AL, Culver, DH, Gaynes, RP, et al.Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582–586.CrossRefGoogle ScholarPubMed
7.Gaynes, R, Culver, D, National Nosocomial Infections Surveillance System. Nosocomial methicillin-resistant Staphylococcus aureus (MRSA) in the United States, 1975-1996. Presented at the 35th Annual Meeting of the Infectious Diseases Society of America; September 13-16, 1997; San Francisco, CA. Abstract 727.Google Scholar
8.Center for Disease Control. Isolation Techniques for Use in Hospitals, ed. 2. Washington, DC: U.S. Government Printing Office; 1975.Google Scholar
9.Garner, JS, Simmons, BP. Centers for Disease Control guideline for isolation precautions in hospitals. Infect Control 1983;4:245–325.Google ScholarPubMed
10.Lynch, P, Jackson, MM, Cummings, MJ, Stamm, WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;107:243–246.CrossRefGoogle ScholarPubMed
11.Garner, JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
12.Fridkin, S, Gaynes, R. Antimicrobial resistance in intensive care units. Clin Chest Med 1999;20:303–316.CrossRefGoogle ScholarPubMed
13.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-June 2003, issued August 2003. Am J Infect Control 2003;31:481–498.CrossRefGoogle Scholar
14.Ribner, BS, Landry, MN, Gholson, GL. Strict versus modified isolation for prevention of nosocomial transmission of methicillin-resistant Staphylococcus aureus. Infect Control 1986;7:317–320.CrossRefGoogle Scholar
15.Maguire, GP, Arthur, AD, Boustead, PJ, Dwyer, B, Currie, BJ. Emerging epidemic of community-acquired methicillin-resistant Staphylococcus aureus infection in the Northern Territory. Med J Aust 1996:164:721–723.Google ScholarPubMed
16.Groom, AV, Wolsey, DH, Naimi, RS, et al.Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001;286:1201–1205.CrossRefGoogle Scholar
17.Herold, BC, Immergluck, LC, Maranan, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.CrossRefGoogle Scholar
18.Daum, RS. Community-acquired methicillin-resistant Staphylococcus aureus infections. Pediatr Infect Dis J 1998;17:745–746.CrossRefGoogle ScholarPubMed
19.Hiramatsu, K, Okuma, K, Xue Ma, X, Yamamoto, M, Hori, S, Kapi, M. New trends in Staphylococcus aureus infections: glycopeptide resistance in the hospital and methicillin resistance in the community. Curr Opin Infect Dis 2002;15:407–413.CrossRefGoogle Scholar
20.Anonymous. Public Health Dispatch: outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections—Los Angeles County, California, 2002-2003. MMWR 2003;52:88.Google Scholar
21.Fey, PD, Said-Salim, B, Rupp, ME, et al.Comparative molecular analysis of community- or hospital-acquired methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2003;47:196–203.CrossRefGoogle ScholarPubMed
22.Saiman, L, O'Keefe, M, Graham, PL 3rd, et al.Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis 2003;37:1313–1319.CrossRefGoogle ScholarPubMed
23.Hill, RL, Duckworth, GJ, Casewell, MW. Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother 1988;22:377–384.CrossRefGoogle ScholarPubMed
24.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:1123–1128.CrossRefGoogle ScholarPubMed
25.Casewell, M, Phillips, I. Hands as route of transmission for Klebsiella species. Br Med J 1977;2:1315–1317.CrossRefGoogle ScholarPubMed
26.Ojajarvi, J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. Journal of Hygiene (Cambridge) 1980;85:193–203.CrossRefGoogle ScholarPubMed
27.Pittet, D, Dharan, S, Touveneau, S, Sauvan, V, Perneger, TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 1999;159:821–826.CrossRefGoogle ScholarPubMed
28.Pessoa-Silva, CL, Dharan, S, Hugonnet, S, et al.Dynamics of bacterial hand contamination during routine neonatal care. Infect Control Hosp Epidemiol 2004;25:192–197.CrossRefGoogle ScholarPubMed
29.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hasp Epidemiol 1997;18:622–627.CrossRefGoogle ScholarPubMed
30.Boyce, JM, Pittet, D, Healthcare Infection Control Practices Advisory Committee, the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. MMWR 2002;51(RR-16):1–44.Google ScholarPubMed
31.Afif, W, Huor, P, Brassard, P, Loo, VG. Compliance with methicillin-resistant Staphylococcus aureus precautions in a teaching hospital. Am J Infect Control 2002;30:430–433.CrossRefGoogle Scholar
32.Richet, H, Wiesel, M, Le Gallou, F, Andre-Richet, B, Espaze, E, the Association des Pays de la Loire pour l'Eviction des Infections Nosocomiales. Methicillin-resistant Staphylococcus aureus control in hospitals: the French experience. Infect Control Hosp Epidemiol 1996;17:509–511.CrossRefGoogle ScholarPubMed
33.Jernigan, JA, Titus, MG, Groschel, DHM, Getchell-White, SI, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496–504.CrossRefGoogle ScholarPubMed
34.Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309–317.CrossRefGoogle Scholar
35.McFarland, LV, Mulligan, ME, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.CrossRefGoogle Scholar
36.Samore, MH, Venkataraman, L, DeGirolami, PC, Levin, E, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.CrossRefGoogle ScholarPubMed
37.Tenorio, AR, Badri, SM, Sahgal, NB, et al.Effectiveness of gloves in preventing personnel hand carriage of vancomycin-resistant Enterococcus (VRE) after patient care. Clin Infect Dis 2001;32:826–829.CrossRefGoogle Scholar
38.Gaynes, R, Marosok, R, Mowry-Hanley, J, et al.Mediastinitis following coronary artery bypass surgery: a 3-year review. J Infect Dis 1991;163:117–121.CrossRefGoogle ScholarPubMed
39.Boyce, JM, Opal, SM, Potter-Bynoe, G, Medeiros, AA. Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis. Clin Infect Dis 1993;17:496–504.CrossRefGoogle Scholar
40.Sherertz, RJ, Reagan, DR, Hampton, KD, et al.A cloud adult: the Staphylococcus aureus-virus interaction revisited. Ann Intern Med 1996;124:539–547.CrossRefGoogle ScholarPubMed
41.Anonymous. DANMAP 1998: Consumption of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Bacteria From Food Animals, Food and Humans in Denmark. Copenhagen, Denmark: Danish Zoonosis Centre; 1999.Google Scholar
42.Vandenbroucke-Grauls CMJE. Methicillin-resistant Staphylococcus aureus control in hospitals: the Dutch experience. Infect Control Hosp Epidemiol 1996;17:512–513.CrossRefGoogle ScholarPubMed
43.Verhoef, J, Beaujean, D, Blok, H, et al.A Dutch approach to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1999;18:461–466.CrossRefGoogle ScholarPubMed
44.Harbarth, S, Martin, Y, Rohner, P, Henry, N, Auckenthaler, R, Pittet, D. Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2004;46:43–49.CrossRefGoogle ScholarPubMed
45.Jernigan, JA, Clemence, MA, Stott, GA, et al.Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.CrossRefGoogle Scholar
46.Karchmer, TB, Cook, EM, Lovato, JF, et al.Active surveillance cultures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci decreased the incidence of new colonization. Presented at the 13th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 5-8, 2003; Arlington, VA. Abstract 257.Google Scholar
47.Ligi, CE, Kohan, CA, Dumigan, DG, Havill, NL, Pittet, D, Boyce, JM. A multifaceted approach to improving hand hygiene practices among healthcare workers using an alcohol-based hand gel. Presented at the 13th Annual Meeting of the Society for Healthcare Epidemiology of America; April 5-8, 2003; Arlington, VA.Google Scholar
48.Centers for Disease Control and Prevention. NNIS Manual. Atlanta, GA: U.S. Department of Health and Human Services; 1994.Google Scholar
49.Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: cost-benefit analysis in an intensive care unit. JAMA 1999;282:1745–1751.CrossRefGoogle Scholar
50.Papia, G, Louie, M, Tralla, A, Johnson, C, Collins, V, Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 1999;20:473–477.CrossRefGoogle ScholarPubMed
51.Vriens, M, Blok, H, Fluit, A, Troelstra, A, Van Der Werken, C, Verhoef, J. Costs associated with a strict policy to eradicate methicillin-resistant Staphylococcus aureus in a Dutch University Medical Center: a 10-year survey. Eur J Clin Microbiol Infect Dis 2002;21:782–786.CrossRefGoogle Scholar
52.Karchmer, TB, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51:126–132.CrossRefGoogle ScholarPubMed
53.Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B, Multicenter Study Group. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163:181–188.CrossRefGoogle ScholarPubMed

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 14 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 17th January 2021. This data will be updated every 24 hours.

77 Cited by
Hostname: page-component-77fc7d77f9-xz9qf Total loading time: 0.29 Render date: 2021-01-17T04:32:48.396Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags last update: Sun Jan 17 2021 03:53:25 GMT+0000 (Coordinated Universal Time) Feature Flags: { "metrics": true, "metricsAbstractViews": false, "peerReview": true, "crossMark": true, "comments": true, "relatedCommentaries": true, "subject": true, "clr": true, "languageSwitch": true, "figures": false, "newCiteModal": false, "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Do Infection Control Measures Work for Methicillin-Resistant Staphylococcus aureus?
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Do Infection Control Measures Work for Methicillin-Resistant Staphylococcus aureus?
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Do Infection Control Measures Work for Methicillin-Resistant Staphylococcus aureus?
Available formats
×
×

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *