Infection Control Program for MRSA in Intensive Care Units

Methicillin-resistant Staphylococcus aureus (MRSA) infection is causing increased morbidity and mortality in intensive care units (ICUs). Its presence causes several challenges in implementing infection control measures. This study determined the incidence of MRSA acquisition in the ICUs and evaluated interventions to reduce the rate of MRSA acquisition.

A prospective study was conducted from April 2004 to March 2013 in the ICUs of our hospital that is a district teaching hospital in Japan. Patients were screened for MRSA with their sputa, nose or throat swabs on admission. MRSA acquisition was defined when negative on admission screening and positive after admission in hospital. The MRSA control program consisted of four practices: 1) frequent oral care with brushing from April 2006, 2) the use of a closed suction system for all patients receiving mechanical ventilation from December 2006, 3) reinforcement of standard precautions for patient contact, with emphasis on hand hygiene, by the supervisory nurse from August 2007, and 4) cleaning equipment and environment with alcohol swab from September 2007.

Of the 9,401 patients examined, 570 (6.06%; 2.9%-9.65%/year) had MRSA on admission. MRSA acquisition rates in the ICU per 1,000 MRSA-negative patients decreased significantly from 28.56 in the three years before the interventions to 14.01 in the 6 years after the interventions (p<0.05).

Although MRSA infection in ICUs has continued, we succeeded in decreasing MRSA acquisition in the ICUs by routine long-term MRSA screening on admission and a MRSA control program.

Keywords: Acquisition, ICU, Infection control, Intervention, MRSA.