Cepeda Jorge A, Whitehouse Tony, Cooper Ben, Hails Janeane, Jones Karen, Kwaku Felicia, Taylor Lee, Hayman Samantha, Cookson Barry, Shaw Steve, Kibbler Chris, Singer Mervyn, Bellingan Geoffrey, Wilson A Peter R
Department of Clinical Microbiology, University College London Hospitals, London W1T 4 JF, UK.
Lancet. 2005;365(9456):295-304. doi: 10.1016/S0140-6736(05)17783-6.
Hospital-acquired infection due to meticillin-resistant Staphylococcus aureus (MRSA) is common within intensive-care units. Single room or cohort isolation of infected or colonised patients is used to reduce spread, but its benefit over and above other contact precautions is not known. We aimed to assess the effectiveness of moving versus not moving infected or colonised patients in intensive-care units to prevent transmission of MRSA.
We undertook a prospective 1-year study in the intensive-care units of two teaching hospitals. Admission and weekly screens were used to ascertain the incidence of MRSA colonisation. In the middle 6 months, MRSA-positive patients were not moved to a single room or cohort nursed unless they were carrying other multiresistant or notifiable pathogens. Standard precautions were practised throughout. Hand hygiene was encouraged and compliance audited.
Patients' characteristics and MRSA acquisition rates were similar in the periods when patients were moved and not moved. The crude (unadjusted) Cox proportional-hazards model showed no evidence of increased transmission during the non-move phase (0.73 [95% CI 0.49-1.10], p=0.94 one-sided). There were no changes in transmission of any particular strain of MRSA nor in handwashing frequency between management phases.
Moving MRSA-positive patients into single rooms or cohorted bays does not reduce crossinfection. Because transfer and isolation of critically ill patients in single rooms carries potential risks, our findings suggest that re-evaluation of isolation policies is required in intensive-care units where MRSA is endemic, and that more effective means of preventing spread of MRSA in such settings need to be found.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的医院获得性感染在重症监护病房很常见。对感染或定植患者采用单人房间或分组隔离以减少传播，但相对于其他接触预防措施，其益处尚不清楚。我们旨在评估在重症监护病房中转移与不转移感染或定植患者以预防MRSA传播的有效性。
我们在两家教学医院的重症监护病房进行了一项为期1年的前瞻性研究。通过入院筛查和每周筛查来确定MRSA定植的发生率。在中间的6个月里，MRSA阳性患者除非携带其他多重耐药或须上报的病原体，否则不转移到单人房间或进行分组护理。全程实施标准预防措施。鼓励手部卫生并对依从性进行审计。
在患者转移和不转移的时期，患者特征和MRSA获得率相似。粗略（未调整）的Cox比例风险模型显示，在不转移阶段没有证据表明传播增加（0.73 [95% CI 0.49 - 1.10]，单侧p = 0.94）。在不同管理阶段，任何特定MRSA菌株的传播以及洗手频率均无变化。
将MRSA阳性患者转移到单人房间或分组区域并不能减少交叉感染。由于将重症患者转移和隔离到单人房间存在潜在风险，我们的研究结果表明，在MRSA流行的重症监护病房需要重新评估隔离政策，并且需要找到在这种环境中预防MRSA传播的更有效方法。
