A Systematic Review of Strategies for MRSA Infection Prevention

This report presents a systematic review of various strategies employed to prevent Methicillin-resistant Staphylococcus aureus (MRSA) infections in healthcare settings. The review meticulously analyzes 15 studies, including randomized controlled trials, cluster randomized trials, and retrospective studies, to evaluate the effectiveness of diverse interventions. These interventions encompass a wide range of approaches, such as hand hygiene campaigns, contact precautions, admission screening strategies, the use of gloves and gowns, antiseptic body washes, and environmental cleaning protocols. The studies were conducted across multiple countries, including Hong Kong, Germany, the Netherlands, the United States, Singapore, and the UK, providing a broad perspective on MRSA prevention practices. The findings highlight the importance of multimodal hygiene management, universal screening, and the use of various technologies and practices to reduce MRSA infection rates. The data extraction tables provide a detailed overview of each study's aim, research design, data collection methods, interventions, and outcomes, offering valuable insights for healthcare professionals and researchers seeking to improve infection control measures.

FIGURE 1. PRISMA Flow Diagram (Moher et al. 2009)
Records identified through different
database searches (CINAHL,
MEDLINE, Academic Search
Complete and ERIC) n=490
Records after duplicates removed
n=280
Records screened n= 280
Records excluded based on title
and abstract screening (n=250)
Full-text articles
assessed for eligibility
(n=30)
Full text articles excluded with
reasons (n=15)
Not as a preventive intervention (n=8).
Interventions considering non-adult
patients (paediatrics, neonates) (n=3)
Not hospital based (n=4)
Studies included n=15
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Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
Cheng et al.
(2014),
Hong Kong
To control
nosocomial
transmission of
methicillin-
resistant
Staphylococcus
aureus (MRSA)
in resource-
limited
healthcare
setting with
high
endemicity.
Retrospective
Study (n =
1600)
Specimens for
microbiologica
l investigation
and changes in
incidence rates
per 1000
patient
admissions,
per 1000
patient days
and per 1000
MRSA
positive days
All MRSA
positive
patients in a
1600 bed,
university
affiliated
hospital from
1st January
2004 to 31st
December
2012.
Three phase infection
control interventions:
first 48 months of
standard precautions,
second 24 months of
hand hygiene campaign
and 36 months of
contact precautions with
continuation of hand
washing and daily
bathing with 2%
chlorhexidine gluconate.
Incidence rates
of hospital
acquired MRSA
infections
Included in
the
Systematic
Review
Gerlich et al.
(2015),
Germany
To improve
hospital
hygiene for the
reduction of
impact
underlying
multi-drug
Prospective
Controlled
Multicenter
Study (n =
1000)
Questionnaires
and
documentation
s sheets for
recording
hygiene
measures
Administratio
n of a
multimodal
system of
hygiene
management
in eight acute
Administration of
HARMONIC
(Harmonized Approach
to avert Multidrug-
resistant Organisms and
Nosocomial Infections)
study comprising of
Screening rates
of MRSA, VRE
MRGN in
patients with
high risk,
frequency of
MRSA
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
resistant
infections in
healthcare
organizations
care hospitals written and regional
recommendations on for
antibiotic prescriptions
and prevention of
infections from
methicillin-resistant
Staphylococcus aureus
(MRSA), vancomycin-
resistant Enterococci
(VRE) and multi-
resistant Gram-negative
bacteria (MRGN).
decolonization,
level of
knowledge
among health
workers and
types of
antibiotics used
Gurieva,
Bootsma and
Bonten
(2013),
Netherlands
To assess the
effects and
costs of various
admission
screening
strategies to
control MRSA
infection
transmission
Case control
study
comprising
of multiple
scenario
analysis
using
Mathematic
Model based
study (n =
220, 000)
Mathematical
model to
assess effects
and costs and
different
screening
strategies and
identification
of critical
parameters
underlying
MRSA
transmission
prevention
Usage of a
dynamic
stochastic
model across
general and
intensive care
unit wards in
3 hospitals
and usage of a
mathematical
model to
assess effects
and costs and
different
Universal screening and
screening and isolation
of patients
Cost and effects
of different
MRSA
admission
screening
strategies
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
screening
strategies and
identification
of critical
parameters
underlying
MRSA
transmission
prevention
Harris et al.
(2013),
United
States
To assess
whether
wearing gloves
and gowns for
all patient
contact in the
ICU decreases
acquisition of
MRSA
infections
Cluster
Randomized
trial (n = 26,
180)
Collection of
microbial
swabs before
and after usage
of gloves and
gowns
Cluster
randomized
trial in
medical,
surgical and
ICU units of
20 hospitals
Usage of gloves and
gowns during entering
patient rooms
Incidences of
MRSA
infections
Included in
the
Systematic
Review
Harris et al.
(2015),
Singapore
To explore
association
between
antiseptic body
washes and
MRSA
infection
Cluster
crossover
study (n =
10, 936)
Prospective
cluster
crossover
study to
compare daily
octenidine
body washes
Cluster
crossover
study across 2
intensive care
units and 5
adult medical
units with
Daily octenidine
washing of patients with
soap and water
Rates of MRSA
infection
acquisition.
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
transmission with soap and
water and
MRSA
acquisition
inclusion of
10936
patients,
washed with
soap and
water
followed by
surveillance of
MRSA
infection
surveillance
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
Kohlenberge
t al. (2015),
Germany
To assess
screening and
control
measures of
MRSA
infections in
intensive care
units
Survey
Questionnair
e – Pre and
Post Survey
Study (n =
186)
Generalized
linear
regression
models on
association
between
MRSA cases
and survey
questionnaire
results
Pre and post
survey
analysis using
generalized
linear
regression
models and
survey
questionnaire
across 186
intensive care
units and
MRSA cases
occurring
from 2007 to
2008.
Universal admission
screening and
assessment on MRSA
incidence densities
MRSA
incidence
densities
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
Lawes et al.
(2012),
Scotland
To explore
trends in
MRSA
preventive
practices and
trends MRSA
incidence in a
hospital in
Scotland from
2006 to 2010
Retrospective
cohort and
time series
intervention
analysis (n =
420, 452)
Quasi
experimental
before and
after study
using time
series data for
assessment of
impact of
universal
screening
administration
on MRSA
incidences
along with
other infection
control
procedures
Before and
after study
after
administration
of universal
screening
program on
MRSA
incidences
between 2006
and 2010 in a
teaching
hospital in
North East
Scotland
Screening of MRA
infections and usage of
cephalosporin and
fluoroquinlone.
MRSA
incidence
density.
Included in
the
Systematic
Review
Lee et al.
(2009),
Canada
To evaluate
impact of
mandatory
infection
control training
program on
MRSA
infection
Before and
after study (n
= 470)
Measurement
of rate of
MRSA
acquisition per
100 patient
admission days
for 3 time
periods (June
Before and
after study
assessing
MRSA
acquisition
rate after
administration
of education
Implementation of
infection control
education program
MRSA infection
incidence.
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
acquisition 2002 –
February 2003,
June 2003-
February 2004,
June 2004-
Febraury 2005
program upon
hospital staff
in a 472
university-
affiliated,
urban hospital
Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
Lei, Jones
and Li
(2017),
China
To explore
effectiveness of
surface cleaning
strategies to
prevent MRSA
infection
transmission
Mathematical
Model based
experimental
study (n = 3)
Concentration
of MRSA
(CFU/min) on
high touch and
low touch
surfaces after
administration
of wipe and
whole room
cleaning
strategies
Mathematical
Model based
experimental
study in a
hypothetical
hospital
environmental
(n = 3)
Wipe and whole room
cleaning strategies on
high and low touch
surfaces
MRSA
transmission and
incidence rates
Included in
the
Systematic
Review
Mitchell et
al. (2014),
Australia
To explore the
role of
hydrogen
peroxide
decontaminatio
n on MRSA
control
Single
centered
retrospective
study (n =
3600)
Interrupted
time series
analysis on
evaluation of
MRSA
incidence after
cleaning with
hydrogen
Cleaning of
3600
discharge
rooms in a a
general
hospital
followed by
processing of
Decontamination of
rooms with hydrogen
peroxide and detergent
cleaning after patient
discharge
Decontaminatio
n of rooms with
hydrogen
peroxide and
detergent
cleaning after
patient
discharge will
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
peroxide after
patient
discharge
32, 600
environmental
swabs after
cleaning with
hydrogen
peroxide
result in reduced
MRSA infection
incidences in
newly admitted
patients.
Moody et al.
(2013), USA
To assess
healthcare
associated
MRSA
infection
preventive
practices in
adult-intensive
care units, in a
large
community
hospital sysrem
Cross
sectional
study using
electronic
Survey
measuring
compliance
with
evidence
based
infection
control
practices and
identification
of variation
in usage
methods and
products (n =
1695)
An electronic
survey
measuring (1)
hospital and
ICU features
such as type,
number of
admissions,
and
average length
of stay; (2)
self-
assessment of
average
compliance
with basic
infection
prevention
processes; (3)
MRSA
Survey
responses on
usage of
evidence
based practice
bundles from
99 intensive
care units
across 55
hospitals
MRSA screening, use of
chlorhexidine practices,
usage of antimicrobial
technology, MRSA
decolonization
Usage and
compliance to
MRSA
preventive
evidence based
practices
associated with
reduced MRSA
infection rates.
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
prevention
strategies in
use, including
screening,
isolation, and
decolonization;
(4)
environmental
cleaning
practices; and
(5) use of
special
approach
technology for
prevention of
central line and
ventilator
associated
Infections.
Roisin et al.
(2014),
Belgium
To evaluate the
impact of rapid
molecular
screening and
MRSA
infection
transmission
Cluster
Randomized
trial (n =
3704)
Cluster
randomized
crossover trial
assessing rate
of MRSA
acquisition
after usage of
3704 patients
across medical
and surgical
wards – one
group
screened using
PCR based
Rapid molecular
screening upon hospital
admission
Cumulative rate
of MRSA
hospital
acquisition of in
patients
screened
negative on
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ

Author
(Year) and
Country
Aim Research
Design
Data
Collection and
Instruments
Sample and
Setting
MRSA Preventive
Measures/Intervention
s
Outcomes Quality
Assessmen
t
PCR screening
randomly
allocated seven
hospital wards
to control or
intervention
groups
screening test
as compared
to another
group
screened using
chromogenic
agar screening
culture
admission.
Sadsad et al.
(2013),
Australia
To evaluate
MRSA
prevention
policies across
hospitals as per
ward specialty
Retrospective
design (n =
980)
Modelling
study
evaluating
MRSA
prevention
policies and
risk of MRSA
transmission in
intensive,
medical and
surgical ward
specialties
Evaluation of
MRSA
prevention
policies and
risk of MRSA
transmission
in intensive,
medical and
surgical ward
specialties in a
tertiary
hospital in
Sydney
Australia
Hand hygiene, MRSA
screening, patient
isolation, additional
staffing.
Rates of MRSA
infection
acquisition
Included in
the
Systematic
Review
Salgeet al.
(2017), UK
To identify
organizational
factors in
prevention of
Longitudinal
Study (n =
173)
Collection of
trust level
panel data
(archival and
Collection of
trust level
panel data
(archival and
General cleaning,
infection control
training, hand hygiene
and conducive error
MRSA
transmission
rates across
NHS trusts.
Included in
the
Systematic
Review
Table 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZTable 1: Data Extraction Table: Summary of Research Design and Study Outcomes (n = XYZ