Background:
In 2007, Objective: To assess the effectiveness of MRSA active surveillance in identifying MRSA-colonized
ICU patients and implementing Contact Precautions. Methods: Hospitals in Results: All 26 eligible hospitals participated in both PPSs; combined results are reported. 1011 adults and 533
neonatal patients participated (Table). Hospital compliance with admission
surveillance was 95% for adults, 98% for neonates. Hospital-reported MRSA admission prevalence was 9.3% for adults, 1.3% for
neonates. MRSA prevalence on day of PPS was 12.4% for
adults, 5.3% for neonates. On day of PPS, 26% of adults and 5% of neonates were
on contact isolation for any reason. Of patients with hospital-reported
admission cultures known to be MRSA positive, 87% of
adults and 86% of neonates were in Contact Precautions. Of patients with PPS
cultures positive for MRSA, 52% (95% CI 43 – 61%) of
adults and 39% (95% CI 22 – 59%) of neonates were in Contact Precautions. Of 77
PPS-identified MRSA-colonized patients not in Contact
Precautions, 20 had pending admission cultures on day of PPS (later finalized
as 8 MRSA+, 12 MRSA-),
51 had known admission culture results (6 MRSA+, 45 MRSA-), and 6 had no admission cultures performed.
Conclusions: In a region with high compliance with mandated MRSA active surveillance and initiation of Contact
Precautions for known MRSA-positive patients, PPSs demonstrated that at a given point in time,
approximately half of MRSA-colonized ICU patients
were not in Contact Precautions. Whether this rate of Contact Precautions is
sufficient to reduce MRSA transmission and infection
is unclear. Inadequate MRSA active surveillance test
sensitivity (e.g., failure to detect colonization at non-cultured body sites),
lag time for results, lack of post-admission periodic surveillance and on-going
nosocomial MRSA acquisition may explain the Contact
Precautions deficit.