Impact of an MRSA search and destroy policy in a tertiary care emergency department

Introduction

An emergency department (ED) is a major hospital entrance and its case mix consists of patients at high risk of both introducing and acquiring infections. Alerted by the rise of hospital-acquired MRSA infections, the ED of a teaching hospital set up an ED infection control (IC) programme. The programme and its impact are discussed.

Methods

The campaign consisted of the appliance of a proactive MRSA admission screening protocol, selective contact isolation (quarantine) and improving hand hygiene (HH). The MRSA admission screening strategy took into account past medical history or actual suspicion of MRSA carriage, transfers from other hospitals and long-term care facilities and admission of hospitalised patients to the ED for upgrading of care. According to their critical illness status, some patients were subject to quarantine. Improving HH was achieved by promoting alcohol-based hand disinfection, refraining all health care workers (HCW) from wearing hand jewellery or artificial fingernails, supplying HCW with clip watches and by developing promotional material. Education of HCW regarding principles and techniques of HH was provided by the IC department, supervised by link persons selected among medical, nursing and domestic staff. The number of new hospital-acquired MRSA infections per 1,000 admissions was recorded. Compliance to HH was measured by observation, microbiological analysis of total counts of colony-forming units on fingerprints, and by monitoring the consumption of hand-rub solutions (HH moments per patient-care day).

Results

A selective MRSA admission screening policy increased the carrier detection rate up to 15%, compared with 1–2% in our preoperative outpatient clinic. The observed compliance to HH increased from 49% to 79% and consumption of hand-rub solution from 6 to 33 l per 1,000 patient-days. The number of HH moments increased from 19 to 47. Total counts of colony-forming units less than 50 improved from 39% of the analyses to 55%. Concomitantly, a decrease in MRSA attack rate from six to one new case per 1,000 patient-days was seen.

Conclusion

An ED tailored selective MRSA screening and contact isolation protocol and a change in HH behaviour in the ED have mainly contributed to a decrease of the MRSA attack rates in our hospital far below the national rate.