TABLE 1.
Comparison of outcome measures with various approaches to MRSA control
| Intervention studied | Population (no. of patients) | Outcome measureda | Results | Significance | Reference or report |
|---|---|---|---|---|---|
| Universal glove and gown isolation | Cluster-randomized trial in 20 ICUs (26,180) | Acquisition of MRSA (secondary); HAI (secondary) | Reduction from 10.03 to 6 MRSA acquisitions/1,000 patient days for intervention; 6.98 to 5.94 for control; no change in HAI | P = 0.046 for reduced acquisition of MRSA colonization; all HAI rates increased for intervention (P = 0.16 to 0.68) | 10 |
| Universal decolonization with mupirocin and chlorhexidine | Cluster-randomized trial in 74 ICUs (122,464) | Rate of MRSA BSI (primary); rate of MRSA clinical culture (secondary) | Change from 0.46 to 0.49 MRSA BSI/1,000 patient days for group 1, from 0.47 to 0.56 for group 2, and from 0.58 to 0.38 for group 3; reduction from 3.4 to 3.1 MRSA clinical cultures/1,000 patient days for group 1, 4.3 to 3.2 for group 2, and 3.4 to 2.1 for group 3 | P = 0.11 for change in MRSA BSI; for comparison of intervention on MRSA clinical cultures, P = 0.09 for group 2 vs 1, P = 0.003 for group 3 vs 1, and P = 0.16 for group 2 vs 3 | 11 |
| Universal AST (PCR) with isolation and decolonization of MRSA patients | Before-after design in 3 affiliated hospitals (65,369) | Rate of all MRSA clinical infections (primary) | Rate of MRSA clinical infection was 0.89 cases/1,000 patient days during baseline period, 0.74/1,000 during ICU testing period, and 0.39 during universal admission AST period | No significant difference between baseline and ICU periods (P = 0.15); difference was significant between baseline and universal AST period (P < 0.001) | 9 |
| Universal AST (PCR) with isolation of MRSA patients | Before-after design in 153 affiliated hospitals (1,934,598) | Rate of all MRSA clinical infections (primary) and rate of MRSA transmission (primary) | Rate of MRSA disease in the ICU changed from 1.64 cases/1,000 patient days at beginning to 0.62 at the end, and the non-ICU rate went from 0.47 to 0.26 cases/1,000 patient days; rate of transmission in the ICU changed from 3.02 cases/1,000 patient days at beginning to 2.5 at the end with the non-ICU rate going from 2.54 to 2 cases/1,000 patient days | Change in both clinical infection and transmission was significant in the ICU and non-ICU populations (P < 0.001 for all comparisons) | 13 |
| Universal AST (PCR) with isolation of MRSA patients | Before-after design in 153 affiliated hospitals (2,382,952) | Rate of all MRSA clinical infections (primary) and rate of MRSA transmission (primary) | Rate of MRSA disease in the ICU changed from 0.54 cases/1,000 patient days at beginning to 0.46, and the non-ICU rate went from 0.29 to 0.16 cases/1,000 patient days, with the combined rate changing from 0.33 to 0.21 clinical infections/1,000 patient days; rate of transmission in the ICU changed from 2.54 cases/1,000 patient days at beginning to 2.36 at the end with the non-ICU rate going from 2.27 to 1.96 cases/1,000 patient days | The change in both clinical infection and transmission was not significant in the ICU, but was in the non-ICU and overall populations (P < .001 for these latter comparisons) | 14 |
| Universal (culture) or targeted (PCR) AST with isolation and decolonization vs enhanced hand hygiene | Before-after-before quasi-experimental design in 33 surgical units at 10 hospitals in 9 countries (126,750) | Rate of all MRSA clinical infections (primary) and rate of MRSA surgical site infections (primary) | Only significant reductions in MRSA infections were for clean surgical patients (n = 43,166 procedures); AST and decolonization had 15% reduction in disease per month, with 18% in the combined arm; after multivariable analysis, AST and decolonization provided a 17% reduction per month in total MRSA infection | No impact from enhanced hand hygiene; for clean surgery, significance of AST plus decolonization was P = 0.019, combined with hand hygiene was it P = 0.007, and multivariable MRSA reduction was P = 0.041 | 15 |
| Targeted AST (culture) vs universal AST with contact precautions isolation of positives | Before-after-before quasi-experimental design in 3 hospitals (147,975) | Rate of newly identified nosocomial MRSA patients (clinical infection and AST results combined; primary); MRSA nosocomial infection (secondary) | Rate of nosocomial MRSA was 0.42 cases/1,000 patient days with targeted AST and 0.48 during universal AST; MRSA BSI was 1.8 and 2.1 cases/100,000 patient days, respectively; MRSA detection rate prevalence was 0.98% during targeted and 2.6% during universal AST periods | No significant differences found for MRSA transmission; nonsignificant reduction of MRSA nosocomial infection of 0.011 cases/1,000 patient days during universal AST | 17 |
| Universal and targeted AST (PCR) with isolation with or without decolonization | Before-after design in 4 affiliated hospitals (501,129) | Rate of all MRSA clinical infections (primary) | Final rate of MRSA clinical infection was 0.23 cases/1,000 patient days during AST period; the fourth hospital was added during the 10-yr period and achieved the same level of MRSA HAI as the original three hospitals after 3 yr (Fig. 1) | Difference was significant between aggregate baseline and AST periods at P < 0.001; targeted, risk-based screening began in January 2012 | New data in current report |
a
HAI, hospital-acquired infection; BSI, bloodstream infection.