Skip to main content Accessibility help

Sustained Reduction in the Clinical Incidence of Methicillin-Resistant Staphylococcus aureus Colonization or Infection Associated with a Multifaceted Infection Control Intervention

  • Katherine Ellingson (a1), Robert R. Muder (a2), Rajiv Jain (a2), David Kleinbaum (a1), Pei-Jean I. Feng (a1), Candace Cunningham (a2), Cheryl Squier (a2), Jon Lloyd (a2), Jonathan Edwards (a1), Val Gebski (a3) and John Jernigan (a1)...



To assess the impact and sustainability of a multifaceted intervention to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission implemented in 3 chronologically overlapping phases at 1 hospital.


Interrupted time-series analyses.


A Veterans Affairs hospital in the northeastern United States.

Patients and Participants.

Individuals admitted to acute care units from October 1, 1999, through September 30, 2008. To calculate the monthly clinical incidence of MRSA colonization or infection, the number of MRSA-positive cultures obtained from a clinical site more than 48 hours after admission among patients with no MRSA-positive clinical cultures during the previous year was divided by patient-days at risk. Secondary outcomes included clinical incidence of methicillin-sensitive S. aureus colonization or infection and incidence of MRSA bloodstream infections.


The intervention—implemented in a surgical ward beginning October 2001, in a surgical intensive care unit beginning October 2003, and in all acute care units beginning July 2005—included systems and behavior change strategies to increase adherence to infection control precautions (eg, hand hygiene and active surveillance culturing for MRSA).


Hospital-wide, the clinical incidence of MRSA colonization or infection decreased after initiation of the intervention in 2001, compared with the period before intervention (P = .002), and decreased by 61% (P < .001) in the 7-year postintervention period. In the postintervention period, the hospital-wide incidence of MRSA bloodstream infection decreased by 50% (P = .02), and the proportion of S. aureus isolates that were methicillin resistant decreased by 30% (P < .001).


Sustained decreases in hospital-wide clinical incidence of MRSA colonization or infection, incidence of MRSA bloodstream infection, and proportion of S. aureus isolates resistant to methicillin followed implementation of a multifaceted prevention program at one Veterans Affairs hospital. Findings suggest that interventions designed to prevent transmission can impact endemic antimicrobial resistance problems.


Corresponding author

Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, 1600 Clifton Road NE, MS A-31, Atlanta, GA 30333 (


Hide All
1.Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L; The Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Department of Health and Human Services. Accessed April 21, 2010.
2. Infectious Diseases Society of Ameria. Bad bugs, no drugs. Accessed November 7, 2010.
3.Spellberg, B, Guidos, R, Gilbert, D, et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 2008;46(2):155164.
4.Hidron, A, Low, CE, Honig, EG, Blumberg, HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus strain USA300 as a cause of necrotising community-onset pneumonia. Lancet Infect Dis 2009;9(6):384392.
5.Klevens, RM, Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes, R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42(3):389391.
6.Kuehnert, MJ, Hill, HA, Kupronis, BA, Tokars, JI, Solomon, SL, Jernigan, DB. Methicillin-resistant-Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11(6):868872.
7.Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):17631771.
8.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(12):686696.
9.Melzer, M, Eykyn, SJ, Gransden, WR, Chinn, S. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus?. A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 2003;37(11):14531460.
10.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26(2):166174.
11.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36(1):5359.
12.Albrich, WC, Harbarth, S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008;8(5):289301.
13.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43(8):971978.
14.Robksek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409418.
15.Burton, DC, Edwards, JR, Horan, TC, Jernigan, JA, Fridkin, SK. Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA 2009;301(7):727736.
16.Muder, RR, Cunningham, C, McCray, E, et al. Implementation of an industrial systems-engineering approach to reduce the incidence of methicillin-resistant Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2008;29(8):702708.
17.Spear, S, Bowen, H. Decoding the DNA of the Toyota Production System. Harv Bus Rev 1999;77:97106.
18.Lloyd, J, Buscell, P, Lindberg, C. Staff-driven cultural transformation diminishes MRSA. Prevention Strategist 2008;Spring:1015.
19.Singhal, A, Greiner, K, Buscell, P. Do what you can, with what you have, where you are. Deeper Learning 2007;1(4):114. Plexus Institute, Accessed July 31, 2010.
20.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195(3):330338.
21.Cohen, AL, Calfee, D, Fridkin, SK, et al. Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper. Infect Control Hosp Epidemiol 2008;29(10):901913.
22.Shardell, M, Harris, AD, El-Kamary, SS, Furuno, JP, Miller, RR, Perencevich, EN. Statistical analysis and application of quasi experiments to anti-microbial resistance intervention studies. Clin Infect Dis 2007;45(7):901907
23.Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27(4):299309.
24.Durbin, J, Watson, GS. Testing for serial correlation in least squares regression. II. Biometrika 1951;38(1-2):159178.
25.Harbarth, S, Fankhauser, C, Schrenzel, J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299(10):11491157.
26.Pujol, M, Pena, C, Pallares, R, et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-suceptible strains. Am J Med 1996;100(5):509516.
27.Jernigan, JA, Pullen, AL, Flowers, L, Bell, M, Jarvis, WR. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003;24(6):409414.
28.Gorwitz, RJ, Kruszon-Moran, D, McAllister, SK, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008;197(9):12261234.
29.Tenover, FC, McAllister, SK, Fosheim, G, et al. Characterization of Staphylococcus aureus isolates from nasal cultures collected from individuals in the United States in 2001 to 2004. J Clin Microbiol 2008;46(9):28372841.
30.Lipsitch, M, Bergstrom, CT, Levin, BR. The epidemiology of antibiotic resistance in hospitals: paradoxes and prescriptions. Proc Natl Acad Sci USA 2000;97(4):19381943.
31.Cooper, BS, Medley, GF, Stone, SP, et al. Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 2004;101(27):1022310228.

Related content

Powered by UNSILO

Sustained Reduction in the Clinical Incidence of Methicillin-Resistant Staphylococcus aureus Colonization or Infection Associated with a Multifaceted Infection Control Intervention

  • Katherine Ellingson (a1), Robert R. Muder (a2), Rajiv Jain (a2), David Kleinbaum (a1), Pei-Jean I. Feng (a1), Candace Cunningham (a2), Cheryl Squier (a2), Jon Lloyd (a2), Jonathan Edwards (a1), Val Gebski (a3) and John Jernigan (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.