Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units

Am J Infect Control. 2013 May;41(5):422-6. doi: 10.1016/j.ajic.2012.06.006. Epub 2012 Nov 11.


Background: Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a concern in the 22 acute care Veterans Affairs (VA) spinal cord injury units where patients with unique rehabilitation and medical needs and a high risk of infection are treated.

Methods: A bundle was implemented in VA spinal cord injury units consisting of nasal surveillance for MRSA on admission/in-hospital transfer/discharge, contact precautions for patients colonized or infected with MRSA, an emphasis on hand hygiene, and an institutional culture change where infection control became everyone's responsibility.

Results: From October 2007, through June 2011, there were 51,627 admissions/transfers/discharges and 816,254 patient-days of care in VA spinal cord injury units. The percentage of patients screened increased to >95.0%. The mean admission MRSA prevalence was 38.6% ± 19.1%. Monthly HAI rates declined 81% from 1.217 per 1,000 patient-days to 0.237 per 1,000 patient-days (P < .001). Bloodstream infections declined by 100% (P = .002), skin and soft-tissue infections by 60% (P = .007), and urinary tract infections by 33% (P = .07).

Conclusion: Universal surveillance, contact precautions, hand hygiene, and an institutional culture change was associated with significant declines in MRSA HAIs in a setting with a high prevalence of MRSA colonization and a high risk for infection.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / prevention & control*
  • Cross Infection / prevention & control*
  • Female
  • Hospital Units*
  • Hospitals, Veterans
  • Humans
  • Infection Control*
  • Intensive Care Units
  • Male
  • Methicillin Resistance
  • Methicillin-Resistant Staphylococcus aureus
  • Middle Aged
  • Risk
  • Spinal Cord Injuries*
  • Staphylococcal Infections / prevention & control*
  • United States
  • United States Department of Veterans Affairs


  • Anti-Bacterial Agents