Impact of a mandatory infection control education program on nosocomial acquisition of methicillin-resistant Staphylococcus aureus.

Lee, Todd C; Moore, Christine; Raboud, Janet M; Muller, Matthew P; Green, Karen; Tong, Agnes; Dhaliwal, Jastej; McGeer, Allison

OBJECTIVE To assess the impact of an institution-wide infection control education program on the rate of transmission of methicillin-resistant Staphylococcus aureus (MRSA). DESIGN Before-and-after study. SETTING A 472-bed, urban, university-affiliated hospital.Intervention. During the period March-May 2004, all hospital staff completed a mandatory infection control education program, including the receipt of hospital-specific MRSA data and case-based practice with additional precautions. OUTCOME MEASURE The rate of nosocomial MRSA acquisition was calculated as the number of cases of nosocomial MRSA acquisition per 100 days that a person with MRSA colonization or infection detected at admission is present in the hospital ("admission MRSA" exposure-days) for 3 time periods: June 2002-February 2003 (before the Toronto outbreak of severe acute respiratory syndrome [SARS]), June 2003-February 2004 (after the outbreak of SARS), and June 2004-February 2005 (after education). A case of nosocomial acquisition of MRSA colonization or infection represented a patient first identified as colonized or infected more than 72 hours after admission or at admission after a previous hospitalization. RESULTS The rate of nosocomial acquisition of MRSA colonization or infection was 8.8 cases per 100 admission MRSA exposure-days for the period before SARS, 3.8 cases per 100 admission MRSA exposure-days for the period after SARS (P<.001 for before SARS vs after SARS), and 1.9 cases per 100 admission MRSA exposure-days for the period after education (P=.02 for after education vs before education). The volume of alcohol-based handrub purchased was apparently stable, with 4,010 L during fiscal year 2003-2004 (April 2003-March 2004) compared with 3,780 L during fiscal year 2004-2005. The observed rate of compliance with hand washing did not change significantly (40.9% during education vs 44.2% after education; P=.23). The total number of patients screened for MRSA colonization was not different in the 3 periods. CONCLUSIONS The rate of nosocomial acquisition of MRSA colonization or infection decreased after SARS and was further reduced in association with a hospital-wide education program.