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American Journal of Critical Care. 2010;19: 16-26 doi:10.4037/ajcc2009467
Copyright © 2010 by the American Association of Critical-Care Nurses.
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CE Article

Isolation Precautions for Methicillin-Resistant Staphylococcus aureus: Electronic Surveillance to Monitor Adherence

By Elaine L. Larson, RN, PhD, CIC, Bevin Cohen, BA, Barbara Ross, RN, BSN, CIC and Maryam Behta, PharmD. Elaine L. Larson is associate dean for research and professor of therapeutic and pharmaceutical research in the School of Nursing and professor of epidemiology in the Mailman School of Public Health at Columbia University, New York, New York. Bevin Cohen is a project manager at the Center for Interdisciplinary Research to Prevent Antimicrobial Resistance at Columbia University. Barbara Ross is a nurse epidemiologist at New York-Presbyterian Hospital System, New York, New York. Maryam Behta is director of quality research and technology utilization for the New York-Presbyterian Hospital System.

Corresponding author: Elaine L. Larson, RN, PhD, CIC, 630 W 168th St, New York, NY 10032 (e-mail: Ell23{at}columbia.edu).

The Centers for Disease Control and Prevention recently updated guidelines for isolation precautions and added specific recommendations for the management of multidrug-resistant organisms. However, the extent to which these recommendations are followed is unknown. Although the recommendations are based on studies with high internal validity, the effectiveness of these interventions in clinical practice also is unknown. Evidence of the effectiveness of isolation precautions for preventing transmission of infections caused by multidrug-resistant organisms in acute care settings, with methicillin-resistant Staphylococcus aureus as an example, was reviewed. Despite a lack of experimental data, numerous descriptive and correlational studies and a sound theoretical rationale strongly suggest that barrier precautions play an important role in the prevention of transmission of infections due to multidrug-resistant organisms. Two major problems, however, still exist. First, staff members’ adherence to national recommendations on isolation precautions, although insufficiently described, appears to be inadequate. Second, efficient, reproducible methods for ongoing surveillance of practices such as isolation precautions are not readily available. Automated surveillance systems that provide support for making decisions are promising for this purpose, are likely to result in cost savings, and therefore warrant more widespread development, testing, and implementation.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Recognize that barrier precautions are important in preventing transmission of infections due to multidrug-resistant organisms.
  2. Understand that staff members’ adherence to national recommendations on isolation precautions appears to be inadequate.
  3. Describe how automated surveillance systems are promising for ongoing surveillance of isolation precautions.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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Copyright © 2010 by the American Association of Critical-Care Nurses.