Study Purpose:

To evaluate the effectiveness of implementing the new methicillin-resistant Staphylococcus aureus (MRSA) control measures in a tertiary care unit in Japan

Intervention Characteristics/Basic Study Process:

The study was conducted in Japan, where the rate of MRSA was the second highest in the Asia-Pacific region—69.5%—in 2002. Although Japan was following infection control practices, the rate was not going down because its survey for the incidence of MRSA was not standardized. In 2003, according to the Society for Healthcare Epidemiology of America (SHEA), Japan started to strictly follow the evidence-based infection control guidelines, which included wearing gowns, masks, and gloves, in addition to implementing contact isolation in a separate room and conducting nasal swab cultures for colonization before discontinuing isolation. Two basic metrics also have been included to conduct surveys on the basis of SHEA and the Infection Control Practices Advisory Committee. To conduct this study, the authors have reviewed patients' data from January 2003–December 2010.

Sample Characteristics:

• N = 1,000
• AGE: No specific age noted
• MALES, FEMALES: Not noted
• KEY DISEASE CHARACTERISTICS: MRSA

Setting:

• SITE: Single site           
• SETTING TYPE: Inpatient           
• LOCATION: Tertiary care center in Japan

Phase of Care and Clinical Applications:

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Elder care

Study Design:

• Quasi-experimental cohort study conducted to evaluate the changes of MRSA incidence and MRSA bloodstream infection (BSI) incidence after implementation of the infection control practices in the tertiary care center

Measurement Instruments/Methods:

•  SAS (version 9.2)

Results:

The study showed a significant reduction in MRSA infection or colonization and MRSA BSI (p < .0001) after strongly implementing the new infection control practices in the tertiary setting.

Conclusions:

This was the first study conducted at a tertiary level in Japan. It was based on the evidence based-practice showing a significant reduction in MRSA spread and MRSA infection burden, which was proved after strictly following the new practices of MRSA control, including isolating the patient. Through this study, the authors also standardized in discontinuing the isolation of MRSA patients based on SHEA and the Infection Control Practices Advisory Committee.

Limitations:

• Measurement/methods not well described
• Measurement validity/reliability questionable
• Other limitations/explanation: This study implemented multifaceted interventions, and defining the relative effect of each intervention is impossible. The test used is only able to detect the outcomes and cannot detect changes in trends.

Nursing Implications:

Nurses play an important role in implementing infection control practices, as nurses are the one who come into contact with patients first. Nurses can follow these guidelines and also advise other healthcare workers to do the same.