Table 3 Review of literature on the single room isolation and/or hand hygiene practice as the predominant measures to control the spread of methicillin-resistant Staphylococcus aureus in adult intensive care unit.
Study [reference] | Design and setting | Main intervention | Major outcome | Remark |
|---|---|---|---|---|
Cepeda JA et al (2005) [7] | Prospective 12-month study in the ICU of 2 teaching hospitals (18-bed for hospital A & 10-bed for hospital B), London, UK | Phase 1 (6-month): all MRSA-positive patients were moved to single room or cohort nursed Phase 2 (7-12 month): all MRSA-positive patients were not moved or cohort nursed Other measures: (i) admission and weekly screening for MRSA colonization; (ii) hand hygiene was encouraged and compliance audited | MRSA acquisition rates in ICU were similar in phase 1 and 2 | Suboptimal patient screening, delay in the availability of MRSA results, and low adherence to hand hygiene (21%) |
Huang SS et al (2006) [2] | Retrospective 9-year study in 8 ICUs in an 800-bed hospital, Boston, US | Phase 1 (since 1 Sept 2000): campaign for sterile CVC placement Phase 2 (since 1 Sept 2001): institution of alcohol-based hand rubs Phase 3 (since 1 Jul 2002): hand hygiene campaign Phase 4 (since 1 Sept 2003): routine admission and weekly screening for MRSA colonization and initiation of contact isolation precaution | Significant reduction in MRSA bacteremia by 75% (p = 0.007) in ICU during phase 4 | Other interventions were not associated with a significant change in MRSA bacteremia |
Bracco D et al (2007) [3] | Prospective 30-month study in a 18-bed medico-surgical ICU (6 single-bed rooms plus a 6-bed and 2-bed bay room), Montreal, Canada | Placement of patients into single room or bay room according to the availability of place Other measures: (i) admission and weekly screening for MRSA colonization; (ii) hand hygiene practice with alcohol-based hand solution | The rate of MRSA acquisition was significantly lower in single room (1.3 per 1000-patient-days) than bay room (4.1 per 1000-patient-days) (p < 0.001) | Placement in single room may reduce MRSA cross-transmission in the institution where MRSA is not hyperendemic |
Gastmeier P et al (2004) [4] | Questionnaire surveillance to 212 ICUs participating in KISS | To enquire the infection control practice in preventing nosocomial MRSA infection; univariate and multivariate analyses to identify risk factors for nosocomial MRSA infection | 164 (77.4%) ICUs response; placement in isolation rooms or cohorts was found to be a protective factor (OR, 0.36; CI95, 0.17-0.79) in multivariate analysis | Up to 34% of the German ICUs have not isolated MRSA patients in single rooms or cohorts |
Harrington G et al (2007) [5] | Prospective 40-month study in a 35-bed ICU, Melbourne, Australia | Introduction of antimicrobial hand hygiene gel with the consumption of hand hygiene product increased from 78.1 liters per 1000-patient-days to 102.7 liters per 1000-patient-days Other measures: MRSA surveillance feedback program using statistical process control chart | The rate of MRSA acquisition was significant lower in post-intervention (6.7 per 100 patient admission) than baseline (9.3 per 100 admission) (p = 0.047) | No admission and weekly screening for MRSA; no placement of MRSA patient in single room |
Souweine B et al (2009) [8] | Prospective 4-month study in 2 ICUs (10-bed in a University hospital and 8-bed in a non-teaching hospital), France | Provision of alcohol-based hand rub during the intervention period Other measures: (i) admission and discharge screening for MRSA; (ii) decolonization of MRSA patients with mupirocin nasal ointment | No significant reduction in MRSA colonization and infection after intervention | The sample size was underpower to estimate the difference |