Isolation policies for hospital management of methicillin-resistant Staphylococcus aureus

Systematic review of isolation policies in the hospital management of methicillin-Resistant Staphylococcus aureus: A review of the literature with epidemiological and economic modelling

The rise of MRSA (methicillin-resistant Staphylococcus aureus) continues to be a problem in hospitals throughout the world. In the article entitled "Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus" Cooper (et al. 2003) conducted a literature review of various containment efforts in the UK. Isolation wards proved to be the most common method of containment but studies were conflicting as to their efficacy. The use of a common isolation ward at one hospital "reduced infection, one did not and one resulted in control for many years until a change in strain and/or an increase in the number of patients colonised on admission [and] overwhelmed the institution" (Cooper et al. 2003: 5). There was limited evidence that more proactive efforts at containment such as "single-room isolation with screening, eradication and an extensive hand-hygiene programme reduced MRSA infection and colonization hospital wide" but only one study supported this method; another single study "provided evidence that NC [nurse cohort] in single rooms with screening and eradication reduced infection hospital wide" (Cooper et al. 2003:5). The nurse cohort study used nurses conducting screening of suspected MRSA cases:

The proposed intervention using the Iowa model would use the knowledge gleaned from the literature review to create a multi-tiered prevention program that both reduced the likelihood of MRSA spreading through the hospital and used isolation and containment methods.

Ask a burning question

The first step of any change-related effort is convincing the affected parties of the need for change. In this particular instance, this means communicating to the staff members the vital need to contain MRSA, whether it has been proven to be a threat in that specific hospital or not.

Conduct a literature review

Validation of the proposed program demands a literature review of previous studies identifying effective methods of containment, such as the Cooper (et al. 2003) literature review.

Conducting research

Research about different approaches must be translated into a specifically-planned effort to educate staff about proper hand-washing; the use of trained nurse interviews to flag suspected cases; and using single unit or general ward isolation for patients proven to have contracted the disease.

Change/pilot/evaluate/adopt

This phase involves the actual change implementation. A pilot program is created, then evaluated, and based upon the results a full-scale change is implemented. Programs must be periodically evaluated for efficacy -- as indicated in the Cooper (2003) literature review, some initially successful programs became less so overtime with an increase in the number of patients seen and other environmentally-related changes.