480. Acquisition and Infection Caused by Methicillin-resistant Staphylococcus aureus [MRSA]: A Comparison of Long Term Care Wards [LTCW] before and after Reduction of Isolation Procedures in a U.S. Veterans Affairs Medical Center [VAMC]
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: In 2007, the VA launched an initiative for the control of MRSA designed to improve patient care and financial outcomes. Although only mandated for acute care wards, we opted to implement the same protocol on our LTCW.
Methods: We used PCR to identify patients colonized with MRSA on admission or ward transfer and chromagar at discharge or death. Contact isolation was used for all colonized or infected patients. Hand hygiene was emphasized. In February 2009, we modified isolation on the LTCWs for patients colonized with MRSA who were continent and able to comply with hand hygiene and contain their body substances. These patients were cared for using standard precautions rather than contact isolation.
Results: In the control period [November 2008-January 2009], there were 222 admits [and 5597 patient days (PD)]. In the period after modifying isolation [February-April 2009], there were 173 admits and [5426 PD]. Rates of collection of nasal swabs and compliance with hand hygiene and isolation were the same in both time periods. Rate of acquisition of MRSA colonization or infection/1000 PD fell after the reduction in isolation. Prior to the intervention, there were 1.61 acquisitions/1000 PD [or 4.05/100 admissions]. Among those who acquired MRSA, two new MRSA infections developed during this time. Post-intervention, there were 0.74 acquisitions/1000 patient days [or 2.31/100 admissions]. There were no new MRSA infections among those who acquired MRSA.
Conclusions: These data offer preliminary support for the view that isolation of patients colonized with MRSA who are “clean, continent and cognitive” in long term care units may offer only limited benefit to attempts to control this organism. This has important implications for making LTCW more like community living.
Kent Crossley, MD1, Stephen Ewing, MD1, Tina Scott, RN2, Joseph Thurn, MD, MPH1 and  J. Thurn, None..
T. Scott, None..
K. Crossley, None..
S. Ewing, None., (1)University of Minnesota Medical School, Minneapolis, MN, (2)Minneapolis VAMC, Minneapolis, MN