Comparison of colonization and infection with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterrococcus assessed by a computerized system and active surveillance on an inpatient rehabilitation unit

BACKGROUND/OBJECTIVE: A new computerized system which recognizes patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterrococcus (VRE) resulted in many more patients requiring contact isolation (CI) in the inpatient rehabilitation unit. Although private rooms are required for CI, patients were free to participate in group activities on the unit. The change in recognition of MRSA/VRE patients led to problems with patient access to the rehabilitation program. Our objective was to compare the computerized list of CI patients with active surveillance culturing and to assess the impact of limited use of CI to contain MRSA/VRE. METHODS: From November 2003 through March 2004, surveillance cultures from patientsʹ anterior nares and rectum were obtained on admission and discharge from the rehabilitation unit. Patients were placed on CI only if they had an active infection with MRSA/VRE. Patients with a history of MRSA/VRE, or those currently colonized, but without active infection were not placed on CI. Hand hygiene was encouraged, and patient education about hand hygiene was provided. The number of patients with MRSA and VRE identified by the computer system was compared with surveillance cultures, and the rates of infection and colonization with MRSA/VRE were monitored. RESULTS: Fifty-three percent of MRSA/VRE patients were identified by active surveillance but lacked a history of these organisms in the computer system. Both the computer system and surveillance cultures identified 26% of MRSA/VRE patients. The computer identified 14% of patients who had negative admission cultures. There was no significant increase in MRSA/VRE infection during the study period. Twenty-three of 369 patients had negative admission cultures followed by positive discharge cultures for MRSA/VRE colonization. CONCLUSIONS: Current colonization with MRSA/VRE is more accurately identified by active surveillance than a computerized system which relies on patientsʹ laboratory history. Restriction of CI to patients with active MRSA/VRE infection did not result in increased rates of infection with MRSA/VRE, but may have been correlated with transmission of colonization. Relaxation of CI for colonized patients appears to be a safe practice in the rehabilitation setting and allows more patients access to services.