To Isolate or Not to Isolate? Analysis of Data From the German Nosocomial Infection Surveillance System Regarding the Placement of Patients With Methicillin-Resistant Staphylococcus aureus in Private Rooms in Intensive Care Units

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Abstract
Objective: To investigate whether isolating patients with MRSA in private rooms in ICUs (or cohorting) is a protective factor for nosocomial MRSA infection.Design: Association between nosocomial MRSA infection rates and ICU structure and process parameters in the German Nosocomial Infection Surveillance System (KISS).Setting: Two hundred twelve ICUs participating in KISS in 2001.Methods: In June 2001, a structured questionnaire was sent to the participating ICUs regarding their preventive measures, their type and size, their patient-to-personnel ratios, and routine cultures. Univariate and multivariate analyses were conducted to identify risk factors for nosocomial MRSA infection.Results: The questionnaire was completed by 164 (77.4%) of the ICUs. These ICUs had 325 nosocomial MRSA infections in a 5-year period (1997 to 2001). The mean incidence density of nosocomial MRSA infections was 0.3/1,000 patient-days. Ninety-one ICUs (55.5%) did not register any nosocomial MRSA infections during the observation period. Forty-two ICUs had an incidence density of at least 0.3/1,000 patient-days (75th percentile). Surgical ICUs were found to be a risk factor for a nosocomial MRSA infection rate above this threshold. Multivariate analysis found surgical ICUs to be an independent predictor and isolation in private rooms (or cohorts) to be a protective factor (OR, 0.36; CI95, 0.17-0.79).Conclusion: Many (34.4%) of the German ICUs have not isolated MRSA patients in private rooms or cohorts, a procedure associated with lower MRSA infection rates in this study.

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