Bottom line:  Use of a bundle decreased infection rates of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) at Veterans Affairs (VA) hospitals.

Summary: Jain R, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections.  N Engl J Med. 2011 Apr 14;364(15):1419-30.

The study compared rates of healthcare-acquired MRSA infections at VA units before (October 2005 – March 2007) and after (October 2007 – June 2010) implementation of a care bundle that included universal nasal surveillance for MRSA, contact precautions for patients colonized or infected with MRSA, promotion of hand hygiene, and a change in the workplace culture that made infection control the responsibility of every staff member who had contact with patients. During the period there was a total of  8,318,675 patient days. Rates of MRSA infections in ICU units were reduced by 62% while the rates at units other than ICUs were reduced by 45% during the same period.

Huskins WC, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med. 2011 Apr 14;364(15):1407-18.

This study of 18 ICU units looked at infection rates of MRSA and vancomycin-resistant enterococcus (VRE) in adult ICUs. Units were randomized to receive an intervention (n=10)  of increased surveillance and expanded barriers or to remain the same as a control (n=8). Intervention group patients were assigned to contact precautions based on history of MRSA or VRE in the past 12 months or results of nasal and perianal swabs. Patients in control units had swabs, but contact precautions were instituted based on hospital procedures and were blinded to the swab results. As Figure 3 summarizes, there was no significant difference in change of infection rates between the two groups. Authors concluded that the intervention was unable to reduce the transmission of MRSA and VRE. The surveillance cultures identified a significant subgroup of colonized patients who would not have been recognized otherwise, but the healthcare providers who participated in the study failed to use clean gowns and gloves and perform hand hygiene as often as was required by the intervention.

Two studies of antibiotic care bundles for MRSA in ICUs can be found here.

Reviewed and updated 4/11/2014 ldt