Control of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) by hygienic measures in a general intensive care unit.

Infections are a major cause of death in critically ill patients. As gram-positive organisms are more widespread and methicillin-resistant staphylococci (MRSA, MRSE) are easily distributed in overcrowded Intensive Care Units (ICU), extended hygienic procedures for infection control are most important. We hypothesize that strict regulations and educational programs for medical and nursing personnel are able to control the spread of resistant bacteria. In a four-room 16-bed medico-surgical ICU, we reinforced hygienic procedures and introduced the separation of clean postoperative and multiply injured patients from those with infectious complications, subsequent to an outbreak of MRSA in 1991. MRSA and MRSE isolated from surveillance cultures of bronchial secretions were reduced from an annual rate of 60.0% to 37.7% and 36.4% to 6.2% respectively between the years 1991 and 1992. Accordingly, the number of lower respiratory tract infections and the crude mortality could be reduced. We conclude that prompt implementation of control measures and continuous education of medical personnel are able to control an outbreak of infection with resistant staphylococci in an ICU setting.