774. The Effect of a Methicillin-Resistant Staphylococcus aureus Bundle on the Incidence of Hospital-Acquired Infections with Clostridium difficile, Vancomycin-Resistant Enterococcus and MRSA
Session: Oral Abstract Session: Staph aureus: Screening and Prevention
Friday, October 21, 2011: 3:30 PM
Room: 157ABC

Background:  The impact of isolating MRSA colonized patients on the incidence of hospital-acquired infections due to Clostridium difficile and vancomycin-resistant enterococcus (VRE) has not been well described. We investigated the impact of a MRSA contact isolation protocol on the incidence of hospital-acquired infections due to C. difficile and VRE, in addition to MRSA.

Methods: A retrospective cohort design with two groups was used for this observational study. Subjects were assigned into 2 cohorts, consisting of, respectively, all admissions to a single Veterans Affairs (VA) Medical Center's acute care units before the implementation of the nationwide VA MRSA bundle (March 2005 - February 2007) or all admissions to acute care units after implementation of the MRSA bundle (September 2007 - August 2009). The demographic, clinical characteristics and infection rates of the two groups were compared. Medical records of subjects with positive cultures were reviewed to establish presence of hospital-acquired infection due to VRE, C. difficile or MRSA.

Results: The preimplementation cohort consisted of 6,590 admissions compared to 8,284 post-implementation. The aggregate rate of hospital-acquired infections due to C. difficile, VRE and MRSA decreased after implementation of the isolation initiative (1.08% to 0.75%; p = 0.042). When examining infections due to specific pathogens, only rates of hospital-acquired C. difficile decreased significantly (0.64% to 0.39%; p = 0.041). 30-day mortality decreased from 6.8% to 5.5% (p <0.001). 

Conclusion: These findings suggest that isolating MRSA-colonized patients has an impact on the incidence of hospital acquired C. difficile. We found no significant change in the incidence of MRSA infections in our institution. This contrasts with the results of the recently published VA Initiative to Prevent MRSA, which showed a significant decrease in the incidence of hospital acquired MRSA infections across Veterans Health System hospitals. Factors unique to each institution likely affect the overall effectiveness of a MRSA bundle. Further research should examine the relationship between contact isolation for MRSA and 30-day mortality.

 


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

David Saunders, MD1,2, Emilio Perez-Jorge, MD3, Ronald Markert, PhD2, Patti Hoffman, RN, MPH1, Vanessa Christian, RN, MS1, Laila Fernandes, MD1,2 and Jack Bernstein, MD1,2, (1)Veterans Affairs Medical Center, Dayton, OH, (2)Wright State University, Dayton, OH, (3)Lexington Infectious Diseases, West Columbia, SC

Disclosures:

D. Saunders, None

E. Perez-Jorge, None

R. Markert, None

P. Hoffman, None

V. Christian, None

L. Fernandes, None

J. Bernstein, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.