Reviewed by Jose Lucar, MD, FIDSA, The George Washington University
A national observational study across 121 Veterans Affairs hospitals evaluated how changes in MRSA prevention policies during the COVID‑19 pandemic were associated with healthcare‑associated MRSA infection rates. Using facility‑level MRSA infection data, the authors compared periods when hospitals maintained versus suspended active surveillance testing and contact precautions, practices that were commonly paused early in the pandemic and later variably reinstated.
Initial models with limited covariate adjustment suggested that discontinuation of MRSA precautions was associated with increased MRSA infection rates. However, in mixed‑effects models incorporating facility‑level random effects and baseline MRSA burden, no statistically significant association was observed between changes in MRSA precaution policies and subsequent MRSA rates. These findings suggest that pre‑existing facility MRSA epidemiology played a stronger role in determining outcomes than short‑term policy changes alone.
The study has several important limitations, including its observational design, reliance on facility‑reported policy changes rather than direct measures of adherence, and limited ability to account for concurrent pandemic‑era interventions such as universal masking, expanded PPE use, staffing disruptions, and shifts in patient case mix. These unmeasured or incompletely measured factors likely altered transmission dynamics and may have complicated interpretation of the independent effects of MRSA‑specific prevention practices.
Overall, this study represents a foundational contribution to understanding how MRSA prevention policies function under conditions of system‑wide disruption. The work underscores the central role of baseline facility epidemiology and contextual factors, and it establishes an essential framework for future studies of infection prevention in dynamic healthcare environments. The findings also support the need for flexible, context‑specific infection prevention strategies rather than uniformly applied policies. Future research should prioritize prospective designs, more detailed evaluation of practices affecting MRSA transmission, and identification of which components of MRSA prevention remain most effective under evolving healthcare conditions.
Reference:
Khader K, Haroldsen C, Stevens V, et al. Estimating changes in facility MRSA infection rates due to changes in MRSA precaution policy. Clin Infect Dis. Published online March 13, 2026. doi:10.1093/cid/ciag176
