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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.

From: Sequential introduction of single room isolation and hand hygiene campaign in the control of methicillin-resistant Staphylococcus aureus in 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
  1. Note. CI95, 95% confidence interval; CVC, central venous catheter; ICU, intensive care unit; KISS, Krankenhaus Infektions Surveillance System (German Nosocomial Infection Surveillance System); MRSA, methicillin-resistant Staphylococcus aureus; OR, odd ratio