Compliance with methicillin-resistant Staphylococcus aureus precautions in a teaching hospital

Background: Nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) occurs primarily through the contaminated hands of health care workers who do not follow appropriate precautionary measures. This study investigates various factors associated with compliance with MRSA precautions during routine patient care. Methods: This observational study took place at a teaching hospital in Montreal, Canada. Nurses (184), physicians (41), occupational therapists and physical therapists (19), orderlies (102), housekeeping personnel (28), other health care workers (65), and visitors (49) were anonymously observed. Compliance with MRSA precautions was measured according to appropriate use of gowns and gloves as well as hand hygiene. Results: In 488 observations, the average compliance was 28%. In multivariate analysis, in comparison with nurses, compliance was lower among physicians (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.14 to 0.86), orderlies (OR, 0.37; CI, 0.20.69), visitors (OR, 0.2; CI, 0.08-0.49), housekeeping personnel (OR, 0.06; CI, 0.01-0.47), and other types of health care workers (OR, 0.39; CI, 0.18-0.85), but was higher among occupational and physical therapists (OR, 11.7; CI, 2.55-53.8). Conclusions: Compliance with MRSA precautions is low. The only significant predictor of MRSA compliance was the professional category of the health care worker.