THE ROLE OF INTRA-HOSPITAL PATIENT MOVEMENTS IN COLONISATION WITH METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA): AN ELECTRONIC MEDICAL RECORDS STUDY

Abstract

Methicillin-resistant Staphycoccus aureus (MRSA) remains endemic in Singapore public hospitals despite a substantial reduction in MRSA acquisition over time. This thesis investigated inpatient ward characteristics associated with MRSA acquisition. Further, I assessed the influence of patient transfer dynamics and invasive diagnostic and therapeutic procedures on MRSA acquisition. I analysed hospital-wide, anonymised electronic medical records of a large Singapore public hospital between 2010 and 2013. Ward-level analysis showed that critical care ward, presence of MRSA cohorting beds, median length of stay, ward specialty, MRSA prevalence among patients transferred from other wards were associated with MRSA acquisition. Additionally, ward transfer frequency, undergoing angiography and dialysis, and a greater turnover of both overall and MRSA-colonised inpatients were found to be associated with increased odds of MRSA acquisition. These findings point to a need to strengthen existing control measures, and to better characterise in-patients who experienced transfer and those undergoing angiography and dialysis.