Skip to main content

The Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations

  • Erica S. Shenoy (a1) (a2) (a3) (a4), Hang Lee (a5), Taige Hou (a3), Winston Ware (a6), Erin E. Ryan (a3), David C. Hooper (a1) (a2) (a4) and Rochelle P. Walensky (a2) (a3) (a4)...

To determine the impact of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus (MRSA/VRE) designations, or flags, on selected hospital operational outcomes.


Retrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010–2011.


Operational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Covariates considered included demographic and clinical characteristics: age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination.


Overall, 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 hours (9.63 hours [95% CI, 9.39–9.88] vs 8.60 hours [95% CI, 8.47–8.73]). These patients had 1.19 times the odds of experiencing an acuity-unrelated within-hospital transfer [95% CI, 1.13–1.26] and a mean length of stay 1.76 days longer (7.03 days [95% CI, 6.82–7.24] vs 5.27 days [95% CI, 5.15–5.38]) than patients with no MRSA/VRE flag.


MRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and to improve inpatient flow.

Infect Control Hosp Epidemiol 2016;37:782–790

Corresponding author
Address correspondence to Erica S. Shenoy, MD, PhD, 55 Fruit Street, Bulfinch 334, Infection Control Unit, Massachusetts General Hospital, Boston, MA 02114 (
Hide All

Authors with equal contribution.

Hide All
1. David, MZ, Medvedev, S, Hohmann, SF, Ewigman, B, Daum, RS. Increasing burden of methicillin-resistant Staphylococcus aureus hospitalizations at US academic medical centers, 2003–2008. Infect Control Hosp Epidemiol 2012;33:782789.
2. Jarvis, WR, Jarvis, AA, Chinn, RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am J Infect Control 2012;40:194200.
3. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165S193.
4. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:10S65–S164.
5. Shenoy, ES, Walensky, RP, Lee, H, Orcutt, B, Hooper, DC. Resource burden associated with contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: The patient access managers’ perspective. Infect Control Hosp Epidemiol 2012;33:849852.
6. McLemore, A, Bearman, G, Edmond, MB. Effect of contact precautions on wait time from emergency room disposition to inpatient admission. Infect Control Hosp Epidemiol 2011;32:298299.
7. Johnson, DW, Schmidt, UH, Bittner, EA, Christensen, B, Levi, R, Pino, RM. Delay of transfer from the intensive care unit: a prospective observational study of incidence, causes, and financial impact. Crit Care 2013;17:R128.
8. Bryce, EA, Tiffin, SM, Isaac-Renton, JL, Wright, CJ. Evidence of delays in transferring patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus to long-term-care facilities. Infect Control Hosp Epidemiol 2000;21:270271.
9. Reynolds, C, Kim, D, Kaplan, SH, et al. Are nursing homes less likely to admit methicillin-resistant Staphylococcus aureus carriers? Am J Infect Control 2014;42:6365.
10. National Center for Health Statistics. Health, United States, 2014: With Special Feature on Adults Aged 55–64. Hyattsville, MD: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2015.
11. Council of Teaching Hospitals and Health Systems. COTH Quarterly Survey of Hospital Operations & Financial Performance. Washington, DC: Association of American Medical Colleges; 2013.
12. Shenoy, ES, Kim, J, Rosenberg, ES, et al. Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus: a randomized controlled trial comparing passive and active screening with culture and polymerase chain reaction. Clin Infect Dis 2013;57:176184.
13. Searle, SR, Speed, FM, Milliken, GA. Population marginal means in the linear model: An alternative to least squares means. Am Statistician 1980;34:216221.
14. Singer, AJ, Thode, HC Jr, Viccellio, P, Pines, JM. The association between length of emergency department boarding and mortality. Acad Emerg Med 2011;18:13241329.
15. Sri-On, J, Chang, Y, Curley, DP, et al. Boarding is associated with higher rates of medication delays and adverse events but fewer laboratory-related delays. Am J Emerg Med 2014;32:10331036.
16. Liu, SW, Chang, Y, Weissman, JS, et al. An empirical assessment of boarding and quality of care: delays in care among chest pain, pneumonia, and cellulitis patients. Acad Emerg Med 2011;18:13391348.
17. Detsky, ME, Etchells, E. Single-patient rooms for safe patient-centered hospitals. JAMA 2008;300:954956.
18. Bobrow, M, Thomas, J. Inpatient care facilities. In: Kobus RL, Skaggs RL, Bobrow M, Thomas J, Payette TM, Kliment SA, eds. Building Type Basics for Healthcare Facilities. New York: John Wiley and Sons, 2000:131192.
19. Shenoy, ES, Lee, H, Cotter, JA, et al. Impact of rapid screening for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions. Am J Infect Control 2015.
20. Shenoy, ES, Paras, ML, Noubary, F, Walensky, RP, Hooper, DC. Natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE): a systematic review. BMC Infect Dis 2014;14:177.
21. Ellis, MW, Hospenthal, DR, Dooley, DP, Gray, PJ, Murray, CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39:971979.
22. Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:13931398.
23. Cretnik, TZ, Vovko, P, Retelj, M, et al. Prevalence and nosocomial spread of methicillin-resistant Staphylococcus aureus in a long-term-care facility in Slovenia. Infect Control Hosp Epidemiol 2005;26:184190.
24. Byers, KE, Anglim, AM, Anneski, CJ, Farr, BM. Duration of colonization with vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23:207211.
25. Park, I, Park, RW, Lim, SK, et al. Rectal culture screening for vancomycin-resistant Enterococcus in chronic haemodialysis patients: false-negative rates and duration of colonization. J Hosp Infect 2011;79:147150.
26. Yoon, YK, Lee, SE, Lee, J, et al. Risk factors for prolonged carriage of vancomycin-resistant Enterococcus faecium among patients in intensive care units: a case-control study. J Antimicrob Chemother 2011;66:18311838.
27. Cluzet, VC, Gerber, JS, Nachamkin, I, et al. Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2015;60:14891496.
28. Haverkate, MR, Derde, LP, Brun-Buisson, C, Bonten, MJ, Bootsma, MC. Duration of colonization with antimicrobial-resistant bacteria after ICU discharge. Intensive Care Med 2014;40:564571.
29. Rogers, C, Sharma, A, Rimland, D, et al. Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features. Am J Infect Control 2014;42:249253.
30. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: Preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65S164.
31. van de Glind, I, de Roode, S, Goossensen, A. Do patients in hospitals benefit from single rooms? A literature review. Health Policy 2007;84:153161.
32. Chaudhury, H, Mahmood, A, Valente, M. Advantages and disadvantages of single- versus multiple-occupancy rooms in acute care environments: a review and analysis of the literature. Environment and Behavior 2005;37:760786.
33. Furuno, JP, Perencevich, EN, Johnson, JA, et al. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci co-colonization. Emerging Infectious Diseases 2005;11:15391544.
34. Morgan, DJ, Day, HR, Furuno, JP, et al. Improving efficiency in active surveillance for methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus at hospital admission. Infect Control Hosp Epidemiol 2010;31:12301235.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed