Comparison of control strategies for methicillin-resistant Staphylococcus aureus


      Screening patients for methicillin-resistant Staphylococcus aureus (MRSA) colonization and contact precautions for colonized patients has been recommended when other control measures have been ineffective.


      We compared MRSA transmission rates following implementation of a bundle of control measures that included institutional culture change, surveillance for MRSA infection and transmission, and active screening for colonization in 2 similar Veterans Health Administration hospitals. One hospital employed contact precautions as defined by the Centers for Disease Control and Prevention, and the other hospital modified contact precautions, requiring only the use of gloves.


      During the 4-year study period, there were 1.58 MRSA transmissions per 1,000 patient-days at hospital A and 1.56 MRSA transmissions per 1,000 patient-days at hospital B (P = .98). Both hospitals experienced significant reductions in MRSA health care-associated infections (HAI). There was no difference between hospital A and hospital B in incidence of MRSA HAIs or MRSA surgical site infections. Annual acquisition costs for cover gowns were $183,609 at hospital A and $25,812 at hospital B.


      Significant reductions in MRSA HAI were associated with implementation of the MRSA control bundle. The bundle that included full contact precautions for colonized patients was no more effective in prevention of MRSA transmissions than a similar bundle that omitted the use of cover gowns.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Calfee D.P.
        • Salgado C.D.
        • Classen D.
        • Arias K.M.
        • Podgorny K.
        • Anderson D.J.
        • et al.
        Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals.
        Infect Control Hosp Epidemiol. 2008; 29: S62-S80
        • Wertheim H.F.
        • Vos M.C.
        • Ott A.
        • van Belkum A.
        • Voss A.
        • Kluytmans J.A.
        • et al.
        Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers.
        Lancet. 2004; 364: 703-705
        • Siegel J.D.
        • Rhinehart E.
        • Jackson M.
        • Chiarello L.
        • Health Care Infection Control Practices Advisory Committee
        2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings.
        Am J Infect Control. 2007; 35: S65-S164
        • Apisarnthanarak A.
        • Apisarnthanarak P.
        • Cheevakumjorn B.
        • Mundy L.M.
        Implementation of an infection control bundle in a school to reduce transmission of influenza-like illness during the novel influenza A 2009 H1N1 pandemic.
        Infect Control Hosp Epidemiol. 2010; 31: 310-311
        • Pronovost P.
        • Needham D.
        • Berenholtz S.
        • Sinopoli D.
        • Chu H.
        • Cosgrove S.
        • et al.
        An intervention to decrease catheter-related bloodstream infections in the ICU.
        N Engl J Med. 2006; 355: 2725-2732
        • Al Tawfiq J.A.
        • Abed M.S.
        Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle.
        Am J Infect Control. 2010; 38: 552-556
        • Liau K.H.
        • Aung K.T.
        • Chua N.
        • Ho C.K.
        • Chan C.Y.
        • Kow A.
        • et al.
        Outcome of a strategy to reduce surgical site infection in a tertiary-care hospital.
        Surg Infect. 2010; 11: 151-159
        • Munoz-Price L.S.
        • De La C.C.
        • Adams S.
        • Wyckoff M.
        • Cleary T.
        • McCurdy S.P.
        • et al.
        Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K pneumoniae carbapenemase-producing K pneumoniae outbreak in a surgical intensive care unit in Miami, Florida.
        Infect Control Hosp Epidemiol. 2010; 31: 1074-1077
        • Jain R.
        • Kralovic S.M.
        • Evans M.E.
        • Ambrose M.
        • Simbartl L.A.
        • Obrosky D.S.
        • et al.
        Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections.
        N Engl J Med. 2011; 364: 1419-1430
        • Aboelela S.W.
        • Saiman L.
        • Stone P.
        • Lowy F.D.
        • Quiros D.
        • Larson E.
        Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature.
        Am J Infect Control. 2006; 34: 484-494
        • Srinivasan A.
        • Song X.
        • Ross T.
        • Merz W.
        • Brower R.
        • Perl T.M.
        A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant enterococci in an intensive care unit.
        Infect Control Hosp Epidemiol. 2002; 23: 424-428
        • Puzniak L.A.
        • Leet T.
        • Mayfield J.
        • Kollef M.
        • Mundy L.M.
        To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci.
        Clin Infect Dis. 2002; 35: 18-25
        • Slaughter S.
        • Hayden M.K.
        • Nathan C.
        • Hu T.C.
        • Rice T.
        • Van Voorhis J.
        • et al.
        A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit.
        Ann Intern Med. 1996; 125: 448-456
        • Trick W.E.
        • Weinstein R.A.
        • DeMarais P.L.
        • Tomaska W.
        • Nathan C.
        • McAllister S.K.
        • et al.
        Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility.
        J Am Geriatr Soc. 2004; 52: 2003-2009
        • Huskins W.C.
        • Huckabee C.M.
        • O'Grady N.P.
        • Murray P.
        • Kopetskie H.
        • Zimmer L.
        • et al.
        Intervention to reduce transmission of resistant bacteria in intensive care.
        N Engl J Med. 2011; 364: 1407-1418
        • Bearman G.
        • Rosato A.E.
        • Duane T.M.
        • Elam K.
        • Sanogo K.
        • Haner C.
        • et al.
        Trial of universal gloving with emollient-impregnated gloves to promote skin health and prevent the transmission of multidrug-resistant organisms in a surgical intensive care unit.
        Infect Control Hosp Epidemiol. 2010; 31: 491-497
      1. National Healthcare Safety Network. Available from: Accessed March 1, 2011.

      Linked Article

      • Erratum
        American Journal of Infection ControlVol. 42Issue 1
        • Preview
          In the article, “Comparison of Control Strategies for Methicillin-Resistant Staphylococcus Aureus” by Bessesen et al, in the November issue of the American Journal of Infection Control (2013;41:1048-52), an author was inadvertently not included. Please note the inclusion of Maureen Bunch, MSN, RN, as an additional author to this article.
        • Full-Text
        • PDF