MRSA Prevention Programs Have Conflicting Results

Stepped-up efforts fall short in one study, succeed greatly in another

WEDNESDAY, April 13 (HealthDay News) -- A program involving intensive efforts to prevent the incidence and spread of methicillin-resistant Staphylococcus aureus (MRSA) infections in health care facilities does not appear to be effective, though another program involving the same types of efforts does seem to be, according to two studies with conflicting findings published in the April 14 issue of the New England Journal of Medicine.

W. Charles Huskins, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues evaluated the effect of surveillance and stronger barrier precautions (use of clean gloves and gowns, and hand hygiene) compared with existing practices on the incidence of MRSA or vancomycin-resistant enterococcus (VRE) infection or colonization in intensive care units (ICUs). They found no significant difference between intervention and control ICUs in the mean incidence of colonization or infection with MRSA or VRE, and concluded that the intervention was ineffective at reducing MRSA or VRE transmission; however, they acknowledged that the use of barrier precaution was below the required level.

Rajiv Jain, M.D., from the VA Pittsburgh Healthcare System, and colleagues assessed the implementation of an "MRSA bundle" on health care-associated MRSA infections in VA hospitals nationwide. The bundle involved nasal surveillance for MRSA, contact precautions for patients colonized or infected with MRSA, hand hygiene, and a change that required everyone who had contact with patients to be responsible for infection control. After implementation of the bundle, the rate of MRSA infections in ICUs fell 62 percent, from 1.64 per 1,000 patient-days to 0.62 per 1,000 patient-days. Non-ICU MRSA infections fell 45 percent.

"A program of universal surveillance, contact precautions, hand hygiene, and institutional culture change was associated with a decrease in health care-associated transmissions of and infections with MRSA in a large health care system," Jain and colleagues write.

The first study was supported in part by Merck, Elan Pharmaceuticals, Roche Diagnostics, and Kimberly Clark; two authors disclosed financial relationships with pharmaceutical companies, including Roche.

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