Risk Factors for the Transmission of Methicillin-Resistant Staphylococcus aureus in an Adult Intensive Care Unit: Fitting a Model to the Data

• Published in: The Journal of infectious diseases Vol. 185; no. 4; pp. 481 - 488
• Main Authors: Grundmann, Hajo, Hori, Satoshi, Winter, Bob, Tami, Adriana, Austin, Daren J.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.02.2002; University of Chicago Press; Oxford University Press
• Subjects: Bacteriology; Biological and medical sciences; Cluster Analysis; Cross Infection - etiology; Cross Infection - prevention & control; Cross Infection - transmission; Data transmission; Disease transmission; Epidemiology; Fundamental and applied biological sciences. Psychology; Hospital admissions; Humans; Infection control; Infections; Intensive care; Intensive Care Units; Major Articles; Methicillin Resistance; Methicillin resistant staphylococcus aureus; Microbiology; Models, Biological; Predisposing factors; Risk Factors; Staphylococcal Infections - etiology; Staphylococcal Infections - prevention & control; Staphylococcal Infections - transmission; Staphylococcus aureus; Staphylococcus aureus - drug effects; Resistance; Antibiotic; Risk factor; Bacteria; Micrococcales; Micrococcaceae; Transmission from man to man; Mathematical model; Epidemiology; Staphylococcus aureus
• ISSN: 0022-1899; 1573-6613; 1537-6613
• DOI: 10.1086/338568

Little is known about the amount of cross-transmission, the risk factors for infection, and the relative effectiveness of infection control procedures when methicillin-resistant Staphylococcus aureus (MRSA) infection occurs at highly endemic levels in intensive care units. A cohort study was done to identify exposures associated with cases that likely were the result of cross-transmission (i.e., occurring in clusters and with indistinguishable MRSA macrorestriction profiles). Fitting a simple stochastic model to the ascertained data allowed prediction of the effectiveness of infection control measures. Exposure to relative staff deficit (adjusted rate ratio, 1.05 independent; 95% confidence interval, 1.02–1.09) was the only factor significantly associated with potential transmission (P = .001). It was predicted that a 12% improvement in adherence to handhygiene policies might have compensated for staff shortage and prevented transmission during periods of overcrowding, shared care, and high workload but that this would be hard to achieve.