In the UK, a fifth of all hospital-acquired infections are caused by meticillin-resistant Staphylococcus aureus (MRSA), especially within intensive-care units. Single room or group isolation of patients infected or colonised with MRSA is commonly used to reduce spread, but its benefit over and above other contact precautions is not known.
Peter Wilson, Geoff Bellingan, and colleagues from University College London Hospitals and the Royal Free Hospital, UK, did a prospective 1-year study in the intensive-care units of these two London teaching hospitals. In the middle 6 months, MRSA-positive patients were not moved to a single room or treated as an infected group of patients unless they were at risk of spreading other serious infections. Standard precautions were practised throughout, with hand hygiene encouraged at all times.
Patients' characteristics, staff hand-washing frequency, and MRSA acquisition rates were similar in the periods when patients were moved and not moved. There were no changes in transmission of any particular strain of MRSA or in infection rate between management phases.
Dr Wilson comments: "Our findings challenge the prevailing view that isolation of intensivecare unit patients who are colonised or infected with MRSA in single rooms or cohorts reduces the transmission of MRSA, over and above the use of standard precautions, in an environment in which it is endemic.”
In an accompanying commentary, Donald A Goldmann of the Institute for Healthcare Improvement in Cambridge (Massachusetts, U.S.A.) highlights hand hygiene and proper use of gloves as the most important interventions for preventing contamination of the hands of health care providers - the main ‘vectors' for spreading MRSA in hospitals.
Dr Goldmann states: "Health care institutions simply must expect more reliable performance of essential infection control practices, such as hand hygiene and proper use of gloves.
MEDICA.de; Source: The Lancet