Reduction in healthcare acquisition of MRSA, MRGN and C. difficile following the implementation of risk managed horizontal infection prevention and control precautions

Mrs Joanna Harris1, Mrs Megan Brown1, Mrs Helen Newman1, Mrs Annmaree Wilson1, Mr Scott Lang1, Ms Suzanne Alexander1

1Illawarra Shoalhaven LHD, Wollongong, Australia


The effectiveness of Contact Precautions (CP) in managing patients with multi-resistant organisms (MROs) is increasingly questioned. In this LHD a horizontal infection prevention and control approach was instituted in one of the three larger hospitals (Hospital 1) in 2015. Standard Precautions were strengthened for all patients and routine single-room isolation for MRO colonised patients was discontinued. Single-room isolation continued for patients with enteric symptoms including C. difficile.

This study compares healthcare associated MRO and C. difficile rates at Hospital 1 with the two other larger LHD hospitals.


A retrospective quantitative comparative review of the incidence of healthcare-associated MRSA, VRE, MRGN, CPE and C. difficile. Rates of healthcare-associated MRO and C. difficile in 2018 were compared to those in 2014. Chi squared test was used to calculate statistical significance.


Statistically significant reductions in MRSA (p=0.027), MRGN (p=0.030), and C. difficile (p=0.028) were observed in 2018 compared to 2014 in Hospital 1. Rates in Hospital 2 were reduced but not significantly. Rates at Hospital 3 showed a non-significant increase for C. difficile, MRGN and VRE and a significant increase in MRSA acquisitions in 2018 compared to 2014 (p=0.035) despite this hospital’s reduction in activity and patient numbers. Hospitals 1 and 2 saw increases in activity and patient numbers from 2014 to 2018.


Removal of CP in the management of patients known to be MRO colonised does not increase the rate of healthcare acquisition of MRO in the acute hospital setting. Horizontal precautions may support reduced C. difficile transmission.


Joanna has worked in the field of infection prevention and control nursing for more than 20 years, with experience in both the UK and Australia. She currently manages a highly experienced team of infection prevention and control nurses and the IPC strategy for the Illawarra Shoalhaven LHD which provides hospital inpatient and community based healthcare (including oral health, mental health and drug and alcohol services) to the local population of almost 400,000 people. She has a particular interest in the ethical aspects of infection prevention and control practices and is undertaking a PhD on this topic. Joanna has authored a number of publications on topics as diverse as MRSA, Headlouse prevalence, listeriosis and the ethics of Contact Precautions.

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