The Impact of a "Search and Destroy" Strategy for the Prevention of Methicillin-Resistant Staphylococcus aureus Infections in an Inpatient Rehabilitation Facility

Objective: To determine how the implementation of a methicillin-resistant Staphylococcus aureus (MRSA) control program in an inpatient rehabilitation facility (IRF) affects MRSA health care associated infections (MRSA-HAIs). Design: A retrospective chart review. Setting: IRF affiliated with Vidant Medical Center, an 861-bed, acute-care teaching hospital for The Brody School of Medicine at East Carolina University. Patients: Seventy-nine adult patients in the IRF who developed a MRSA-HAI from February 2005 through January 2011. Interventions: Both the acute care hospital and the affiliated inpatient rehabilitation unit began screening 100% of admissions for MRSA nasal carriage, with decolonization of positive carriers, starting in February 2007. Main Outcome Measurements: Yearly rates of MRSA-HAI per 1000 patient-days were compared in the IRF before and after the intervention. Results: The weighted mean monthly infection rate before the intervention (February 2005 through January 2007) was 1.0714 per 1000 patient days compared with 0.6557 per 1000 patient days after the intervention (February 2007 through January 2011). The decreased infection rates after the intervention were statistically significant (P = .0315). Conclusions: The implementation of an all-admissions MRSA screening program with decolonization of positive carriers in an IRF affiliated with an acute care hospital resulted in decreased MRSA-HAI rates in the IRF. When developing surveillance guidelines for MRSA, IRFs should be cognizant of infection rate trends and of the affiliated hospital's scope of policies and practices for infection prevention and control.