Individual units rather than entire hospital as the basis for improvement: the example of two Methicillin resistant Staphylococcus aureus cohort studies

Two cohort studies of surveillance data were used: Data from a total of 224 hospitals and 359 ICUs in the period from 2004 to 2009. Development over time was described first for both surveillance systems. In a second step only data were analyzed from those hospitals/ICUs with continuous participation for at least four years. Incidence rate ratios (IRR) with 95% confidence intervals were calculated to compare incidence densities between different time intervals.In the baseline year the mean MRSA incidence density of hospital acquired MRSA cases was 0.25 and the mean incidence density of ICU-acquired MRSA was 1.25 per 1000 patient days. No decrease in hospital-acquired MRSA rates was found in a total of 111 hospitals with continuous participation in the hospital- based system. However, in 159 ICUs with continuous participation in the unit-based system, a significant decrease of 29% in ICU-acquired MRSA was identified.A unit-based approach of surveillance and feedback seems to be more successful in decreasing nosocomial MRSA rates, compared to a hospital-based approach. Therefore each surveillance system should provide unit-based data to stimulate activities on the unit level.Aspects of hospital infection control have achieved a great deal of interest from the media, the public and politicians in many countries and many hospitals worldwide are very active in improving the situation. Meanwhile, a considerable body of knowledge about the effectiveness and suitability of specific infection control measures has been established. Comprehensive guidelines have been developed in many countries to support the infection control recommendations in individual hospitals. However, knowledge about the best infection control measures is often not the most important point in improving the situation. In many hospitals compliance with these recommendations is far from ideal and barriers for low compliance must be identified to overcome them.One of the most interesting infection control