Certification in infection control matters: Impact of infection control department characteristics and policies on rates of multidrug-resistant infections


      The study objective is to describe infection control policies aimed at multidrug-resistant organisms (MDRO) in California hospitals and assess the relationship among these policies, structural characteristics, and rates of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) bloodstream infections and Clostridium difficile infections.


      Data on infection control policies, structural characteristics, and MDRO rates were collected through a 2010 survey of California infection control departments. Bivariate and multivariable Poisson and negative binomial regressions were conducted.


      One hundred eighty hospitals provided data (response rate, 54%). Targeted MRSA screening upon admission was reported by the majority of hospitals (87%). The majority of hospitals implemented contact precautions for confirmed MDRO and C difficile patients; presumptive isolation/contact precautions for patients with pending screens were less frequently implemented. Few infection control policies were associated with lower MDRO rates. Hospitals with a certified infection control director had significantly lower rates of MRSA bloodstream infections (P < .05).


      Although most California hospitals are involved in activities to decrease MDRO, there is variation in specific activities utilized with the most focus placed on MRSA. This study highlights the importance of certification and its significant impact on infection rates. Additional research is needed to confirm these findings.

      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


        • Cosgrove S.E.
        • Sakoulas G.
        • Perencevich E.N.
        • Schwaber M.J.
        • Karchmer A.W.
        • Carmeli Y.
        Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.
        Clin Infect Dis. 2003; 36: 53-59
        • Elixhauser A.
        Clostridium difficile-associated disease in U.S. hospitals, 1993-2005.
        AHRQ Healthcare Cost and Utilization Project Statistical Brief. 2008; 50: 1-11
        • Stone P.W.
        • Gupta A.
        • Loughrey M.
        • Della-Latta P.
        • Cimmiotti J.
        • Larson E.
        • et al.
        Attributable costs and length of stay of an extended-spectrum β-lactamase-producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit.
        Infect Control Hosp Epidemiol. 2003; 24: 601-606
        • Cosgrove S.E.
        • Qi Y.
        • Kaye K.S.
        • Harbarth S.
        • Karchmer A.W.
        • Carmeli Y.
        The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges.
        Infect Control Hosp Epidemiol. 2005; 26: 166-174
        • Deshpande L.M.
        • Fritsche T.R.
        • Moet G.J.
        • Biedenbach D.J.
        • Jones R.N.
        Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: a report from the SENTRY antimicrobial surveillance program.
        Diagn Microbiol Infect Dis. 2007; 58: 163-170
        • Klein E.
        • Smith D.L.
        • Laxminarayan R.
        Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005.
        Emerg Infect Dis. 2007; 13: 1840-1846
        • Loo V.G.
        • Libman M.D.
        • Miller M.A.
        • Bourgault A.M.
        • Frenette C.H.
        • Kelly M.
        • et al.
        Clostridium difficile: a formidable foe.
        CMAJ. 2004; 171: 47-48
        • McCusker M.E.
        • Harris A.D.
        • Perencevich E.
        • Roghmann M.C.
        Fluoroquinolone use and Clostridium difficile-associated diarrhea.
        Emerg Infect Dis. 2003; 9: 730-733
        • Boyce J.M.
        Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus?.
        Infect Control Hosp Epidemiol. 1991; 12: 46-54
        • Siegel J.D.
        • Rhinehart E.
        • Jackson M.
        • Chiarello L.
        Management of multidrug-resistant organisms in healthcare settings.
        Centers for Disease Control and Prevention, Atlanta [GA]2006
      1. Association of Professionals in Infection Control, Inc. Elimination of methicillin-resistant Staphylococcus aureus (MRSA) transmission in hospital settings. 2007. Available from: Accessed April 12, 2010.

        • LeDell K.
        • Muto C.A.
        • Jarvis W.R.
        • Farr B.M.
        SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus.
        Infect Control Hosp Epidemiol. 2003; 24: 639-641
        • Muto C.A.
        • Jarvis W.R.
        • Farr B.M.
        Another tale of two guidelines.
        Clin Infect Dis. 2006; 43 (author reply 7-8): 796-797
        • Muto C.A.
        • Jernigan J.A.
        • Ostrowsky B.E.
        • Richet H.M.
        • Jarvis W.R.
        • Boyce J.M.
        • et al.
        SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus.
        Infect Control Hosp Epidemiol. 2003; 24: 362-386
        • 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
        • McGinigle K.L.
        • Gourlay M.L.
        • Buchanan I.B.
        The use of active surveillance cultures in adult intensive care units to reduce methicillin-resistant Staphylococcus aureus-related morbidity, mortality, and costs: a systematic review.
        Clin Infect Dis. 2008; 46: 1717-1725
        • Cooper B.S.
        • Stone S.P.
        • Kibbler C.C.
        • Cookson B.D.
        • Roberts K.A.
        • Medley G.F.
        • et al.
        Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature.
        BMJ. 2004; 329: 533
        • Halcomb E.J.
        • Cert G.
        • Griffiths R.
        • Fernanez R.
        The role of patient isolation and compliance with isolation practices in the control of nosocomial MRSA in acute care.
        Int J Evid Based Healthc. 2008; 6: 206-224
        • Diekema D.J.
        • Climo M.
        Preventing MRSA infections: finding it is not enough.
        JAMA. 2008; 299: 1190-1192
        • Dancer S.J.
        Considering the introduction of universal MRSA screening.
        J Hosp Infect. 2008; 69: 315-320
        • Jarvis W.R.
        • Schlosser J.
        • Chinn R.Y.
        • Tweeten S.
        • Jackson M.
        National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006.
        Am J Infect Control. 2007; 35: 631-637
        • Richet H.M.
        • Benbachir M.
        • Brown D.E.
        • Giamarellou H.
        • Gould I.
        • Gubina M.
        • et al.
        Are there regional variations in the diagnosis, surveillance, and control of methicillin-resistant Staphylococcus aureus?.
        Infect Control Hosp Epidemiol. 2003; 24: 334-341
        • Sunenshine R.H.
        • Liedtke L.A.
        • Fridkin S.K.
        • Strausbaugh L.J.
        Management of inpatients colonized or infected with antimicrobial-resistant bacteria in hospitals in the United States.
        Infect Control Hosp Epidemiol. 2005; 26: 138-143
        • Dillman D.A.
        • Smyth J.D.
        Design effects in the transition to web-based surveys.
        Am J Prev Med. 2007; 32: S90-S96
        • Donabedian A.
        The quality of care. How can it be assessed?.
        JAMA. 1988; 260: 1743-1748
        • Cameron A.C.
        • Trivedi P.K.
        Regression analysis of count data.
        Cambridge University Press, Cambridge [England]1998
      2. UCLA: Academic Technology Services, Statistical Consulting Group. How can I analyze count data in Stata? Available from: Accessed December 20, 2010.

        • Horan T.C.
        • Andrus M.
        • Dudeck M.A.
        CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.
        Am J Infect Control. 2008; 36: 309-332
      3. California Health and Safety Code: Medical Facility Infection Control and Prevention Act. 296 CCR, Section 12558; 2008.

        • Peterson A.
        • Marquez P.
        • Terashita D.
        • Burwell L.
        • Mascola L.
        Hospital methicillin-resistant Staphylococcus aureus active surveillance practices in Los Angeles County: implications of legislation-based infection control, 2008.
        Am J Infect Control. 2010; 38: 653-656
        • Krein S.L.
        • Hofer T.P.
        • Kowalski C.P.
        • Olmsted R.N.
        • Kauffman C.A.
        • Forman J.H.
        • et al.
        Use of central venous catheter-related bloodstream infection prevention practices by US hospitals.
        Mayo Clin Proc. 2007; 82: 672-678