Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission

The Lancet Infectious Diseases

Volumn 8, Issue 7, 2008, Pages 427-434

  Clements, Archie ^a,b   Halton, Kate ^b   Graves, Nicholas ^b,c   Pettitt, Anthony ^c,d   Morton, Anthony ^e   Looke, David ^e   Whitby, Michael ^b,e  

^a UNIVERSITY OF QUEENSLAND   (Australia)

^b Centre for Healthcare Related Infection Surveillance and Prevention (CRISP)   (Australia)

^c QUEENSLAND UNIVERSITY OF TECHNOLOGY   (Australia)

^d LANCASTER UNIVERSITY   (United Kingdom)

^e PRINCESS ALEXANDRA HOSPITAL   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

ALCOHOL; METICILLIN;

ANTIBIOTIC RESISTANCE; AUSTRALIA; BACTERIAL INFECTION; COST CONTROL; CROWDING; DECISION MAKING; DISEASE EXACERBATION; HAND WASHING; HEALTH CARE COST; HEALTH CARE PERSONNEL; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HIGH RISK PATIENT; HOSPITAL ADMISSION; HOSPITAL HYGIENE; HUMAN; INFECTION CONTROL; INFECTION RISK; LENGTH OF STAY; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS; NONHUMAN; PATIENT SAFETY; PRIORITY JOURNAL; REVIEW; RISK REDUCTION; STAFF TRAINING; STAPHYLOCOCCUS INFECTION; WORKLOAD;

BED OCCUPANCY; HEALTH MANPOWER; HOSPITALS; HUMANS; INCIDENCE; LENGTH OF STAY; METHICILLIN RESISTANCE; STAPHYLOCOCCAL INFECTIONS; STAPHYLOCOCCUS AUREUS;

EID: 45749091707     PISSN: 14733099     EISSN: None     Source Type: Journal    
DOI: 10.1016/S1473-3099(08)70151-8     Document Type: Review

References (140)

1. Jevons P. "Celbenin"-resistant staphylococci. BMJ 1 (1961) 124-125
2. Barber M. Methicillin-resistant staphylococci. J Clin Pathol 14 (1961) 385-393
3. Panlilio A., Culver D., Gaynes R., et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 13 (1992) 582-586
4. Anon. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992-June 2001. Am J Infect Control 29 (2001) 404-421
5. Dailey L., Coombs G., O'Brien F., et al. Methicillin-resistant Staphylococcus aureus, western Australia. Emerg Infect Dis 11 (2005) 1584-1590
6. Torvaldsen S., Roberts C., and Riley T. The continuing evolution of methicillin-resistant Staphylococcus aureus in western Australia. Infect Control Hosp Epidemiol 20 (1999) 133-135
7. Health Protection Agency. Staphylococcus aureus bacteraemia: England, Wales and Northern Ireland: January to December 2003. CDR Wkly 14 (2004) 1-5
8. Klevens R., Morrison M., Nadle J., et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 298 (2007) 1763-1771
9. Anon. Deaths involving MRSA: England and Wales, 2000-2004. Health Stat Q 29 (2006) 63-68
10. Griffiths C., Lamagni T., Crowcroft N., Duckworth G., and Rooney C. Trends in MRSA in England and Wales: analysis of morbidity and mortality data for 1993-2002. Health Stat Q 21 (2004) 15-22
11. Reacher M., Shah A., Livermore D., et al. Bacteraemia and antibiotic resistance of its pathogens reported in England and Wales between 1990 and 1998: trend analysis. BMJ 320 (2000) 213-216
12. Ayliffe G. The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 24 suppl 1 (1997) S74-S79
13. Nicolle L., Dyck B., Thompson G., et al. Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 20 (1999) 202-205
14. Gould I. Costs of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) and its control. Int J Antimicrob Agents 28 (2006) 379-384
15. Gonzalez C., Rubio M., Romero-Vivas J., Gonzalez M., and Picazo J. Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 29 (1999) 1171-1177
16. Soriano A., Martinez J., Mensa J., et al. Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 30 (2000) 368-373
17. Gleason T., Crabtree T., Pelletier S., et al. Prediction of poorer prognosis by infection with antibiotic-resistant Gram-positive cocci than by infection with antibiotic-sensitive strains. Arch Surg 134 (1999) 1033-1040
18. Zahar J., Clec'h C., Tafflet M., et al. Is methicillin resistance associated with a worse prognosis in Staphylococcus aureus ventilator-associated pneumonia?. Clin Infect Dis 41 (2005) 1224-1231
19. Combes A., Luyt C., Fagon J., et al. Impact of methicillin resistance on outcome of Staphylococcus aureus ventilator-associated pneumonia. Am J Respir Crit Care Med 170 (2004) 786-792
20. Blot S., Vandewoude K., Hoste E., and Colardyn F. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 162 (2002) 2229-2235
21. Chang F., MacDonald B., Peacock J., et al. A prospective multicenter study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance. Medicine (Baltimore) 82 (2003) 322-332
22. Melzer M., Eykyn S., Gransden W., and Chinn S. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 37 (2003) 1453-1460
23. Selvey L., Whitby M., and Johnson B. Nosocomial methicillin-resistant Staphylococcus aureus bacteremia: is it any worse than nosocomial methicillin-sensitive Staphylococcus aureus bacteremia?. Infect Control Hosp Epidemiol 21 (2000) 645-648
24. Engemann J., Carmeli Y., Cosgrove S., et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 36 (2003) 592-598
25. Mekontso-Dessap A., Kirsch M., Brun-Buisson C., and Loisance D. Poststernotomy mediastinitis due to Staphylococcus aureus: comparison of methicillin-resistant and methicillin-susceptible cases. Clin Infect Dis 32 (2001) 877-883
26. Rello J., Torres A., Ricart M., et al. Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med 150 (1994) 1545-1549
27. Cosgrove S., Sakoulas G., Perencevich E., Schwaber M., Karchmer A., and Carmeli Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 36 (2003) 53-59
28. Whitby M., McLaws M., and Berry G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 175 (2001) 264-267
29. Kopp B., Nix D., and Armstrong E. Clinical and economic analysis of methicillin-susceptible and resistant Staphylococcus aureus infections. Ann Pharmacother 38 (2004) 1377-1382
30. Cosgrove S., Qi Y., Kaye K., Harbarth S., Karchmer A., and Carmeli Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 26 (2005) 166-174
31. Reed S., Friedman J., Engemann J., et al. Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 26 (2005) 175-183
32. Lodise T., and McKinnon P. Clinical and economic impact of methicillin resistance in patients with Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis 52 (2005) 113-122
33. McHugh C., and Riley L. Risk factors and costs associated with methicillin-resistant Staphylococcus aureus bloodstream infections. Infect Control Hosp Epidemiol 25 (2004) 425-430
34. Abramson M., and Sexton D. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs?. Infect Control Hosp Epidemiol 20 (1999) 408-411
35. Aiken L., Clarke S., and Sloane D. Hospital restructuring: does it adversely affect care and outcomes?. J Nurs Adm 30 (2000) 457-465
36. Duckett S. Australian hospital services: an overview. Aust Health Rev 25 (2002) 2-18
37. Sochalski J., Aiken L., and Fagin C. Hospital restructuring in the United States, Canada, and western Europe: an outcomes research agenda. Med Care 35 (1997) OS13-OS25
38. Audit Commission. Bed management. Review of national findings (2003), Audit Commission, London
39. Comptroller General and Auditor General. Improving patient care by reducing the risk of hospital acquired infection: a progress report (2004), House of Commons, London
40. Schofield D., and Earnest A. Demographic change and the future demand for public hospital care in Australia, 2005 to 2050. Aust Health Rev 30 (2006) 507-515
41. Schofield D., and Beard J. Baby boomer doctors and nurses: demographic change and transitions to retirement. Med J Aust 183 (2005) 80-83
42. Buerhaus P., Staiger D., and Auerbach D. Implications of an aging registered nurse workforce. JAMA 283 (2000) 2948-2954
43. Spurgeon D. Canada faces nurse shortage. BMJ 320 (2000) 1030
44. US Department of Health and Human Services. The registered nurse population: findings from the 2004 National Sample Survey of Registered Nurses. http://bhpr.hrsa.gov/healthworkforce/rnsurvey04/ (accessed May 11, 2008).
45. Jackson M., Chiarello L., Gaynes R., and Gerberding J. Nurse staffing and healthcare-associated infections: proceedings from a working group meeting. J Nurs Adm 32 (2002) 314-322
46. Andersen B., Lindemann R., Bergh K., et al. Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect 50 (2002) 18-24
47. Harbarth S., Sudre P., Dharan S., Cadenas M., and Pittet D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 20 (1999) 598-603
48. Archibald L., Manning M., Bell L., Banerjee S., and Jarvis W. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 16 (1997) 1045-1048
49. Haley R., and Bregman D. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 145 (1982) 875-885
50. Smith P., Brookfield D., Shaw D., and Gray J. An outbreak of Serratia marcescens infections in a neonatal unit. Lancet 1 (1984) 151-153
51. Borg M. Bed occupancy and overcrowding as determinant factors in the incidence of MRSA infections within general ward settings. J Hosp Infect 54 (2003) 316-318
52. Cunningham J., Kernohan W., and Sowney R. Bed occupancy and turnover interval as determinant factors in MRSA infections in acute settings in Northern Ireland: 1 April 2001 to 31 March 2003. J Hosp Infect 61 (2005) 189-193
53. Cunningham J., Kernohan W., and Rush T. Bed occupancy, turnover intervals and MRSA rates in English hospitals. Br J Nurs 15 (2006) 656-660
54. Blatnik J., and Lesnicar G. Propagation of methicillin-resistant Staphylococcus aureus due to the overloading of medical nurses in intensive care units. J Hosp Infect 63 (2006) 162-166
55. Grundmann H., Hori S., Winter B., Tami A., and Austin D. Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data. J Infect Dis 185 (2002) 481-488
56. Dancer S., Coyne M., Speekenbrink A., Samavedam S., Kennedy J., and Wallace P. MRSA acquisition in an intensive care unit. Am J Infect Control 34 (2006) 10-17
57. Vicca A. Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J Hosp Infect 43 (1999) 109-113
58. Farrington M., Redpath C., Trundle C., Coomber S., and Brown N. Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infection at a teaching hospital. QJM 91 (1998) 539-548
59. Halwani M., Solaymani-Dodaran M., Grundmann H., Coupland C., and Slack R. Cross-transmission of nosocomial pathogens in an adult intensive care unit: incidence and risk factors. J Hosp Infect 63 (2006) 39-46
60. Robert J., Fridkin S., Blumberg H., et al. The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit. Infect Control Hosp Epidemiol 21 (2000) 12-17
61. Kovner C., and Gergen P. Nurse staffing levels and adverse events following surgery in US hospitals. Image J Nurs Sch 30 (1998) 315-321
62. Haddad Q., Sobayo E., Basit O., and Rotimi V. Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. J Hosp Infect 23 (1993) 211-222
63. Fridkin S., Pear S., Williamson T., Galgiani J., and Jarvis W. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 17 (1996) 150-158
64. Sarvikivi E., Lyytikainen O., Salmenlinna S., et al. Clustering of Serratia marcescens infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 25 (2004) 723-729
65. Dorsey G., Borneo H., Sun S., et al. A heterogeneous outbreak of Enterobacter cloacae and Serratia marcescens infections in a surgical intensive care unit. Infect Control Hosp Epidemiol 21 (2000) 465-469
66. Stegenga J., Bell E., and Matlow A. The role of nurse understaffing in nosocomial viral gastrointestinal infections on a general pediatrics ward. Infect Control Hosp Epidemiol 23 (2002) 133-136
67. Farrington M., Trundle C., Redpath C., and Anderson L. Effects on nursing workload of different methicillin-resistant Staphylococcus aureus (MRSA) control strategies. J Hosp Infect 46 (2000) 118-122
68. Haley R., Cushion N., Tenover F., et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 171 (1995) 614-624
69. Hugonnet S., Chevrolet J., and Pittet D. The effect of workload on infection risk in critically ill patients. Crit Care Med 35 (2007) 76-81
70. Alonso-Echanove J., Edwards J., Richards M., et al. Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infect Control Hosp Epidemiol 24 (2003) 916-925
71. Yang K. Relationships between nurse staffing and patient outcomes. J Nurs Res 11 (2003) 149-158
72. Buerhaus P., and Staiger D. Trouble in the nurse labor market? Recent trends and future outlook. Health Aff (Millwood) 18 (1999) 214-222
73. Hugonnet S., Perneger T., and Pittet D. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Intern Med 162 (2002) 1037-1043
74. Nijssen S., Bonten M., Franklin C., Verhoef J., Hoepelman A., and Weinstein R. Relative risk of physicians and nurses to transmit pathogens in a medical intensive care unit. Arch Intern Med 163 (2003) 2785-2786
75. Karabey S., Ay P., Derbentli S., Nakipoglu Y., and Esen F. Handwashing frequencies in an intensive care unit. J Hosp Infect 50 (2002) 36-41
76. Pittet D., Mourouga P., and Perneger T. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med 130 (1999) 126-130
77. Larson E., and Killien M. Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 10 (1982) 93-99
78. O'Boyle C., Henly S., and Larson E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. Am J Infect Control 29 (2001) 352-360
79. Pittet D., Simon A., Hugonnet S., Pessoa-Silva C., Sauvan V., and Perneger T. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 141 (2004) 1-8
80. Gould D. Nurses' hand decontamination practice: results of a local study. J Hosp Infect 28 (1994) 15-30
81. Bischoff W., Reynolds T., Sessler C., Edmond M., and Wenzel R. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 160 (2000) 1017-1021
82. Bignardi G., and Askew C. Workload may be related to the spread of MRSA and other infections. J Hosp Infect 45 (2000) 78-80
83. Raboud J., Saskin R., Simor A., et al. Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital. Infect Control Hosp Epidemiol 26 (2005) 607-615
84. McBryde E., Pettitt A., and McElwain D. A stochastic mathematical model of methicillin resistant Staphylococcus aureus transmission in an intensive care unit: predicting the impact of interventions. J Theor Biol 245 (2007) 470-481
85. Preston G., Larson E., and Stamm W. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 70 (1981) 641-645
86. Pittet D. Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 48 suppl A (2001) S40-S46
87. Maury E., Alzieu M., Baudel J., et al. Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am J Respir Crit Care Med 162 (2000) 324-327
88. Johnson P., Martin R., Burrell L., et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 183 (2005) 509-514
89. Conly J., Hill S., Ross J., Lertzman J., and Louie T. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 17 (1989) 330-339
90. Pittet D., Hugonnet S., Harbarth S., et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 356 (2000) 1307-1312
91. Larson E., Early E., Cloonan P., Sugrue S., and Parides M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 26 (2000) 14-22
92. Beggs C., Noakes C., Shepherd S., Kerr K., Sleigh P., and Banfield K. The influence of nurse cohorting on hand hygiene effectiveness. Am J Infect Control 34 (2006) 621-626
93. Kibbler C., Quick A., and O'Neill A. The effect of increased bed numbers on MRSA transmission in acute medical wards. J Hosp Infect 39 (1998) 213-219
94. Collignon P., Grayson M., and Johnson P. Methicillin-resistant Staphylococcus aureus in hospitals: time for a culture change. Med J Aust 187 (2007) 4-5
95. Cooper B., Medley G., Stone S., et al. Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 101 (2004) 10223-10228
96. Taunton R., Kleinbeck S., Stafford R., Woods C., and Bott M. Patient outcomes. Are they linked to registered nurse absenteeism, separation, or work load?. J Nurs Adm 24 suppl 4 (1994) 48-55
97. Zimmerman S., Gruber-Baldini A., Hebel J., Sloane P., and Magaziner J. Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors. J Am Geriatr Soc 50 (2002) 1987-1995
98. Casewell M. New threats to the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 30 suppl (1995) 465-471
99. Dancer S. Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 8 (2008) 101-113
100. Kim T., Oh P., and Simor A. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 22 (2001) 99-104
101. Shorr A., Tabak Y., Gupta V., Johannes R., Liu L., and Kollef M. Morbidity and cost burden of methicillin-resistant Staphylococcus aureus in early onset ventilator-associated pneumonia. Crit Care 10 (2006) R97
102. Cooper B., Stone S., Kibbler C., et al. Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling. Health Technol Assess 7 (2003) 1-194
103. Haley R., Schaberg D., Von Allmen S., and McGowan J. Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis 141 (1980) 248-257
104. Barrett S., Mummery R., and Chattopadhyay B. Trying to control MRSA causes more problems than it solves. J Hosp Infect 39 (1998) 85-93
105. Beaujean D., Blok H., Gigengack-Baars A., et al. Five-year surveillance of patients with communicable diseases nursed in isolation. J Hosp Infect 47 (2001) 210-217
106. Cooper C., Dyck B., Ormiston D., et al. Bed utilization of patients with methicillin-resistant Staphylococcus aureus in a Canadian tertiary-care center. Infect Control Hosp Epidemiol 23 (2002) 483-484
107. Herr C., Heckrodt T., Hofmann F., Schnettler R., and Eikmann T. Additional costs for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward. Infect Control Hosp Epidemiol 24 (2003) 673-678
108. Fitzpatrick F., Murphy O., Brady A., Prout S., and Fenelon L. A purpose built MRSA cohort unit. J Hosp Infect 46 (2000) 271-279
109. Papia G., Louie M., Tralla A., Johnson C., Collins V., and Simor A. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective?. Infect Control Hosp Epidemiol 20 (1999) 473-477
110. Vriens M., Blok H., Fluit A., Troelstra A., Van Der Werken C., and Verhoef J. Costs associated with a strict policy to eradicate methicillin-resistant Staphylococcus aureus in a Dutch University Medical Center: a 10-year survey. Eur J Clin Microbiol Infect Dis 21 (2002) 782-786
111. Cepeda J., Whitehouse T., Cooper B., et al. Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 365 (2005) 295-304
112. Bootsma M., Diekmann O., and Bonten M. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci USA 103 (2006) 5620-5625
113. Adrie C., Alberti C., Chaix-Couturier C., et al. Epidemiology and economic evaluation of severe sepsis in France: age, severity, infection site, and place of acquisition (community, hospital, or intensive care unit) as determinants of workload and cost. J Crit Care 20 (2005) 46-58
114. Girou E., Stephan F., Novara A., Safar M., and Fagon J. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 157 (1998) 1151-1158
115. O'Boyle C., Jackson M., and Henly S. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control 30 (2002) 321-333
116. Saulnier F., Hubert H., Onimus T., et al. Assessing excess nurse work load generated by multiresistant nosocomial bacteria in intensive care. Infect Control Hosp Epidemiol 22 (2001) 273-278
117. Chaix C., Durand-Zaleski I., Alberti C., and Brun-Buisson C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 282 (1999) 1745-1751
118. Blok H., Troelstra A., Kamp-Hopmans T., et al. Role of healthcare workers in outbreaks of methicillin-resistant Staphylococcus aureus: a 10-year evaluation from a Dutch university hospital. Infect Control Hosp Epidemiol 24 (2003) 679-685
119. Cox R., and Conquest C. Strategies for the management of healthcare staff colonized with epidemic methicillin-resistant Staphylococcus aureus. J Hosp Infect 35 (1997) 117-127
120. Kniehl E., Becker A., and Forster D. Bed, bath and beyond: pitfalls in prompt eradication of methicillin-resistant Staphylococcus aureus carrier status in healthcare workers. J Hosp Infect 59 (2005) 180-187
121. Trundle C., Farrington M., Anderson L., and Redpath C. GRASPing infection: a workload measurement tool for infection control nurses. J Hosp Infect 49 (2001) 215-221
122. Veldhuijzen I., Bronzwaer S., Degener J., and Kool J. European Antimicrobial Resistance Surveillance System (EARSS): susceptibility testing of invasive Staphylococcus aureus. Euro Surveill 5 (2000) 34-36
123. National Centre for Antimicrobials and Infection Control. Annual report on Staphylococcus aureus bacteraemia cases in Denmark (2002), Staphylococcus Laboratory, National Centre for Antimicrobials and Infection Control (Staten Serums Institut), Copenhagen
124. Infection Control Service. South Australian statewide 2005 nosocomial multi-resistant organism (MRO) report (2006), Communicable Disease Control Branch, Infection Control Service, South Australia Department of Health, Adelaide
125. Centre for Infections. Surveillance of Healthcare Associated Infections report 2007 (2007), Healthcare Associated Infection and Antimicrobial Resistance Department, Centre for Infections, Health Protection Agency, London
126. National Audit Office. The management and control of hospital acquired infection in acute NHS trusts in England: executive summary and recommendations (2000), National Audit Office, London
127. Haley R., White J., Culver D., et al. The efficacy of infection surveillance and control programmes in preventing nosocomial infections in US hospitals. Am J Epidemiol 121 (1985) 182-205
128. Harbarth S., Sax H., and Gastmeier P. The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 54 (2003) 258-266
129. Jernigan J., Titus M., Groschel D., Getchell-White S., and Farr B. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 143 (1996) 496-504
130. Cosseron-Zerbib M., Roque A.A., Naas T., et al. A control programme for MRSA (methicillin-resistant Staphylococcus aureus) containment in a paediatric intensive care unit: evaluation and impact on infections caused by other micro-organisms. J Hosp Infect 40 (1998) 225-235
131. Wernitz M., Keck S., Swidsinski S., Schulz S., and Veit S. Cost analysis of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment. Clin Microbiol Infect 11 (2005) 466-471
132. Jernigan J., Clemence M., Stott G., et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 16 (1995) 686-696
133. Bjorholt I., and Haglind E. Cost-savings achieved by eradication of epidemic methicillin-resistant Staphylococcus aureus (EMRSA)-16 from a large teaching hospital. Eur J Clin Microbiol Infect Dis 23 (2004) 688-695
134. Karchmer T., Durbin L., Simonton B., and Farr B. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 51 (2002) 126-132
135. Hartstein A., Denny M., Morthland V., LeMonte A., and Pfaller M. Control of methicillin-resistant Staphylococcus aureus in a hospital and an intensive care unit. Infect Control Hosp Epidemiol 16 (1995) 405-411
136. Webster J., Faoagali J., and Cartwright D. Elimination of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan. J Paediatr Child Health 30 (1994) 59-64
137. Zafar A., Butler R., Reese D., Gaydos L., and Mennonna P. Use of 0·3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. Am J Infect Control 23 (1995) 200-208
138. Graves N. Economics and preventing hospital-acquired infections. Emerg Infect Dis 10 (2004) 561-566
139. Graves N., Halton K., and Lairson D. Economics and preventing hospital-acquired infection: broadening the perspective. Infect Control Hosp Epidemiol 28 (2007) 178-184
140. Cameron P. Hospital overcrowding: a threat to patient safety? Managing access block involves reducing hospital demand and optimising bed capacity. Med J Aust 184 (2006) 203-204