Summary of the timing and nature of infection control interventions for each study arm
| Standard precautions | HH promotion | MRSA screening | MRSA isolation | MRSA decolonisation | |
|---|---|---|---|---|---|
| Baseline phase: 6–7 months (1 March 2008 to 31 January 2009)* | |||||
| Enhanced HH arm | –† | – | – | – | – |
| Screening and decolonisation arm | – | – | – | – | – |
| Combined arm | – | – | – | – | – |
| Intervention phase: 12 months (1 October 2008 to 31 January 2010)* | |||||
| Enhanced HH arm | Adherence to standard precautions (eg, gloves and other barriers as needed for contact with mucous membranes, wounds and body fluids) during care of all patients encouraged | HH promotion using the WHO multi-modal HH promotion method.15 Observation of 100 opportunities for HH per ward per month | – | – | – |
| Screening and decolonisation arm | – | – | Universal screening of patients admitted for more than 24 h, on admission then weekly (see ‘MRSA screening details’ in footnotes) | Patients MRSA colonised/infected placed on contact precautions (gown and gloves during contact). Patients with MRSA placed in single rooms or cohorted based on local capacity. Pre-emptive isolation of previously unknown MRSA carriers pending screening results not used | Patients MRSA colonised/infected given twice-daily intranasal mupirocin and daily chlorhexidine body washes (5 days) |
| Combined arm | Adherence to standard precautions (eg, gloves and other barriers as needed for contact with mucous membranes, wounds and body fluids) during care of all patients encouraged | HH promotion using the WHO multimodal HH promotion method.15 Observation of 100 opportunities for HH per ward per month | Targeted screening based on risk factors (see ‘MRSA screening details’ in footnotes) | Patients MRSA colonised/infected placed on contact precautions (gown and gloves during contact). Patients with MRSA placed in single rooms or cohorted based on local capacity. Pre-emptive isolation of previously unknown MRSA carriers pending screening results not used | Patients MRSA colonised/infected given topical decolonisation therapy at discretion of treating clinicians |
| Washout phase: 6 months (1 October 2009 to 31 July 2010)* | |||||
| Enhanced HH arm | – | – | – | – | – |
| Screening and decolonisation arm | – | – | – | – | – |
| Combined arm | – | – | Targeted screening based on risk factors (see ‘MRSA screening details’ in footnotes) | Patients MRSA colonised/infected placed on contact precautions (gown and gloves during contact). Patients with MRSA placed in single rooms or cohorted based on local capacity. Pre-emptive isolation of previously unknown MRSA carriers pending screening results not used | Patients MRSA colonised/infected given topical decolonisation therapy at discretion of treating clinicians |
*The start of the study period was staggered for hospitals. For each study phase, the start date is the date on which the first hospital entered the study phase and the end date indicates the date on which the last hospital completed the study phase.
†There were no specific interventions as part of the study. Hospitals employed their usual infection control practices during these study phases.
MRSA, meticillin-resistant Staphylococcus aureus; HH, hand hygiene.
MRSA screening details: Screening of nares, perineum and wounds (if present).
Universal screening (intervention phase) was used in the screening and decolonisation arm. It refers to screening patients admitted for more than 24 h and excluded patients undergoing ambulatory surgery and those screened within 5 days prior to admission to the surgical ward.
Targeted screening (intervention and washout phases) was used in the two centres in the combined arm due to introduction of local and national mandatory screening policies. One study centre (hospital 4) screened patients previously known to be MRSA positive, contacts of patients with MRSA and patients transferred from the intensive care unit or other healthcare facilities. The other centre (hospital 7) not only screened patients with the same risk factors as hospital 4, but also included nursing home residents, patients admitted to the hospital in the last 3 months, patients transferred from another ward within the same hospital and those admitted to vascular or abdominal surgery subspecialties.