A Multifaceted Infection Control Intervention Is Successful in Decreasing MRSA
Hi, this is Dr. William Jarvis, President of Jason and Jarvis Associates and Medscape Infectious Diseases expert advisor. We've seen a continuation of the debate about whether active surveillance testing of patients for methicillin-resistant Staphylococcus aureus (MRSA) -- thereby identifying both colonized as well as infected patients and placing them in contact isolation with hand hygiene and environmental cleaning (otherwise known as active detection and isolation) -- should be fully implemented. This month in Infection Control & Hospital Epidemiology, Ellingson and colleagues, from the Centers for Disease Control and Prevention (CDC) in collaboration with the Veteran's Affairs (VA) Hospital in Pittsburgh, looked at the sustainability of such a program of active detection and isolation. This practice was started in October 2001 in the surgical ward, expanded in October 2003 to the surgical intensive care unit and then in July 2005 to all acute care units.

The interventions were relatively simple. One intervention involved systems and behavioral changes. Initially, in October 2001 through October 2003, they used the Toyota production system, and then in July 2005 they changed to the use of positive deviance. The second intervention was hand hygiene and environmental disinfection. The third was active surveillance testing of anterior nares or open wounds, if they existed, within 48 hours of admission. The investigators looked at both MRSA colonization and infection. With these interventions, MRSA colonization and infection decreased by 61%, bloodstream infections decreased by 50%, and the proportion of Staphylococcus aureus resistant to methicillin decreased by 30%. When they looked individually at the different units, the surgical ward MRSA colonization and infection rate decreased by 35%, the surgical ward rate decreased by 41%, and the rate in the acute care wards decreased by 40%. The hospital-wide reduction in MRSA colonization and infection was 22%. Therefore, this intervention using active surveillance testing, contact isolation, hand hygiene, and environmental cleaning produces significant decreases in MRSA colonization and infection.

Of interest, it really didn't matter whether the investigators used the Toyota production system or positive deviance. Many interventions using active detection or isolation with either the Toyota production system or positive deviance have also seen a significant decrease in MRSA rate. The bottom line is that we should use active detection and isolation, which is active surveillance testing at the time of admission and then placing patients who are colonized or infected with MRSA in contact isolation and reinforcing the appropriate application of contact isolation together with environmental disinfection. It's not clear how many more studies are going to be necessary before general adoption of such programs is implemented. The VA hospital system is doing it hospital-wide and in every VA hospital across the country, and now this study in collaboration with the CDC documents the efficacy of such an intervention. We know how to prevent MRSA infections from occurring. The question is when -- when will we fully implement this active detection program?

Thank you very much. Until next time, this is Dr. William Jarvis.