A sustained reduction in the transmission of methicillin resistant Staphylococcus aureus in an intensive care unit.

INTRODUCTION

In 2001, screening for methicillin-resistant Staphylococcus aureus (MRSA) was initiated in the intensive care unit at Dandenong Hospital, Melbourne, Australia. This followed the identification of a clinical isolate of vancomycin intermediate-resistant S. aureus (VISA). Contact precautions for patients colonised or infected with MRSA or VISA were utilised, together with the promotion of hand hygiene and additional environmental cleaning. In 2004, poor compliance with hand-hygiene requirements was recognised as potentially contributing to the inability to control MRSA transmission.

METHODS

A renewed campaign was introduced in 2004, aimed at improving hand hygiene in the ICU. This involved the introduction of an alcoholic chlorhexidine handrub station on a trolley at the door of the ICU. Use of alcoholic chlorhexidine handrub was mandated for existing and visiting staff to the ICU, and its use was actively promoted by all ICU staff.

RESULTS

From 2001 to 2004, the average monthly acquisition of MRSA in the unit was 15.2 patients per 1000 occupied bed days (OBD). Following the implementation of the campaign aimed at visiting staff, the average acquisition of MRSA dropped to 3.2 patients per 1000 OBD.

CONCLUSIONS

Ownership of hand-hygiene responsibility for patients' protection appeared to contribute to the success of this initiative. The ability to sustain the excellent result was enhanced by the unit leadership and the empowerment of the nurse at the bedside to be the patient's advocate. Nurses, who are at the patient bedside 24 hours per day, 7 days per week, are well positioned to reinforce appropriate hand hygiene.