No MRSA here!

At the end of each quarter I prepare a report on HAIs in our ICUs and examine the trends. In doing so last week, I had a pleasant surprise--for the first time ever, we had no device related MRSA HAIs in any of our 8 ICUs (136 beds, >8,600 patient days for the 3-month period). Moreover, our infection rates from all pathogens was the lowest ever. Now I didn't fall out of my chair since we have been watching a progressive decrease in the rate of MRSA infections over the past several years. This decline in MRSA parallels the fall in our infection rates in general. To what do we attribute all of this? Our belief is that a strong horizontal platform of infection control with non-pathogen specific strategies has led to this success. Probably most important has been our focus on hand hygiene (median ICU rates consistently exceed 90%) and the use of chlorhexidine for patient bathing. Now one could correctly argue that our uncontrolled observations cannot establish causation. However, I think the most important and irrefutable fact is that this fall in infection rates, including those caused by MRSA, cannot be attributed to active surveillance for MRSA, since our NICU is the only ICU in which active surveillance is performed. Despite my happiness at MRSA's absence, I'll refrain from the use of words like elimination or eradication, and won't even say we got to zero, since I'm certain this crafty bug is not about to leave us alone.