Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (XMSA): Systematic review of the literature

Article English OPEN
Cooper, BS ; Stone, SP ; Kibbler, CC ; Cookson, BD ; Roberts, JA ; Medley, GF ; Duckworth, G ; Lai, R ; Ebrahim, S (2004)

Objective To evaluate the evidence for the effectiveness of isolation measures in reducing the incidence of methicillin resistant Staphylococcus aureus (MRSA) colonisation and infection in hospital inpatients. Design Systematic review of published articles. Data sources Medline, Embase, CINAHL, Cochrane Library, System for Information on Grey Literature in Europe (SIGLE), and citation lists (1966-2000). Review methods Articles reporting MRSA related outcomes and describing an isolation policy were selected. No quality restrictions were imposed on studies using isolation wards or nurse. cohorting. Other studies were included if they were prospective or employed planned comparisons of retrospective data. Results 46 studies were accepted; 18 used isolation wards, nine used nurse cohorting, and 19 used other isolation policies. Most were interrupted time series, with few planned formal prospective studies. All but one reported multiple interventions. Consideration of potential confounders, measures to prevent bias, and appropriate statistical analysis were mostly lacking. No conclusions could be drawn in a third of studies. Most others provided evidence consistent with a reduction of MRSA acquisition. Six long interrupted time series provided the strongest evidence. Four of these provided evidence that intensive control measures including patient isolation were effective in controlling MRSA. In two others, isolation wards failed to prevent endemic MRSA. Conclusion Major methodological weaknesses and inadequate reporting in published research mean that many plausible alternative explanations for reductions in MRSA acquisition associated with interventions cannot be excluded. No well designed studies exist that allow the role of isolation measures alone to be assessed. None the less, there is evidence that concerted efforts that include isolation can reduce MRSA even in endemic settings. Current isolation measures recommended in national guidelines should continue to be applied until further research establishes otherwise.
  • References (74)
    74 references, page 1 of 8

    1 Public Health Laboratory Service. The first year of the Department of Health's mandatory MRSA bacteraemia surveillance scheme in acute NHS trusts in England: April 2001-March 2002. Commun Dis Rep CDR Wkly [serial online] 2002;12: (accessed 22 Jul 2004).

    2 Hiramatsu K, Hanaki H, Ino T. Methicillin resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997;40:135-6.

    3 Turnidge JD, Bell JM Methicillin-resistant Staphylococcus aureus evolution in Australia over 35 years. Microb Drug Resist 2000;6:223-9.

    4 Centers for Disease Control and Prevention. National nosocomial infection surveillance systems report, data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2002;30:458-75.

    5 Garner JS. Hospital infection control practices advisory commitee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53-80.

    6 Wierkgroup Infectie Preventie. Management policy for methicillin-resistant Staphylococcus aureus. Guideline No. 35A. Leiden: WIP, 1994.

    7 Ministry of Health. Guidelines for the control of methicillin-resistant Staphylococcus aureus in New Zealand. Wellington: MoH, 2002. 49ba80c00757b8804c256673001d47d0/e5231b74a5dc8b22cc256c220017b248/ $FILE/mrsa.pdf (accessed 12 Jul 2004).

    8 British Society for Antimicrobial Chemotherapy, Hospital Infection Society and the Infection Control Nurses Association. Revised guidelines for the control of methicillinresistant Staphylococcus aureus infection in hospitals. J Hosp Infect 1998;39:253-90.

    9 Rahman M, Sanderson PJ, Bentley AH, Barrett SP, Karim QN, Teare EL, et al. Control of MRSA. J Hosp Infect 2000;44:151-3.

    10 Boyce JM. Nosocomial staphylococcal infections. Ann Intern Med 1981;95:241-2.

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