Researchers say that while isolation and hand hygiene are important to help curb the transmission of pathogenic organisms, compliance with these infection control measures rely largely on a personal commitment to them by healthcare professionals.
Cheng, et al. (2010) report in a study published in BMC Infectious Diseases that after renovation of the adult intensive care unit (ICU) with installation of 10 single rooms, an enhanced infection control program was conducted to control the spread of methicillin-resistant Staphylococcus aureus (MRSA) in a hospital.
Since the ICU renovation, all patients colonized or infected with MRSA were nursed in single rooms with contact precautions. The incidence of MRSA infection in the ICU was monitored during three different phases: the baseline period (phase 1); after ICU renovation (phase 2) and after implementation of a hand hygiene campaign with an alcohol-based hand rub (phase 3). Patients infected with extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species were chosen as controls because they were managed in open cubicles with standard precautions.
Cheng, et al. (2010) report that without a major change in the facilitys bed-occupancy rate, nursing workforce, or the protocol of environmental cleansing throughout the study period, a stepwise reduction in ICU-onset non-bacteremic MRSA infection was observed: from 3.54 (phase 1) to 2.26 (phase 2, p=0.042) and 1.02 (phase 3, p=0.006) per 1000-patient-days. ICU onset bacteremic MRSA infection was significantly reduced from 1.94 (phase 1) to 0.9 (phase 2, p=0.005) and 0.28 (phase 3, p=0.021) per 1000-patient-days. Infection due to ESBL-producing organisms did not show a corresponding reduction. The usage density of broad-spectrum antibiotics and fluoroquinolones increased from phase 1 to 3; however, a significant trend improvement of ICU-onset MRSA infection by segmented regression analysis can only be demonstrated when comparison was made before and after the severe acute respiratory syndrome (SARS) epidemic. The researchers say this suggests that the deaths of fellow healthcare workers from an occupationally acquired infection had an overwhelming effect on their compliance with infection control measures.
The researchers conclude that provision of single-room isolation facilities and promotion of hand hygiene practice are important; however compliance with infection control measures relies largely on a personal commitment, which may increase when personal safety is threatened.
Reference: Cheng VCC, Tai JWM, Chan W, Lau EHY, Jasper, Chan JFW, Kelvin, To KKW, Li IWS, Ho PI and Yuen KY. Sequential introduction of single room isolation and hand hygiene campaign in the control of methicillin-resistant Staphylococcus aureus in intensive care unit. BMC Infectious Diseases 2010, 10:263doi:10.1186/1471-2334-10-263.