The I-STRAT trial: Do Isolation Strategies reduce endemic levels of MRSA and Clostridium difficle associated diarrhoea

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What do most people fear about coming into hospital? Catching a superbug infection such as MRSA or Clostridium difficile! Despite a tranche of Government initiatives to reduce these, they appear rampant. Surely their control should be simple. Keep the hospitals clean! Make sure staff clean their hands! Put people with these infections into isolation straight away! However, it is this last intervention , isolation, that proves so difficult. Infection Control staff often bemoan the lack of effective isolation facilities. Managers say they cannot afford to make more isolation beds available, especially as there is no good evidence from a proper trial to prove this works. This study will get to the bottom of the difficulties in providing effective isolation. It will help Trusts, through a nationwide consultation, and intensive work with 25-30 trusts, to work out the barriers, at organizational and individual levels, to effective isolation. It will help them come up with ideas of how to make isolation facilities available and make the most of those facilities that they have. Trusts will be able to design the isolation policies they think most likely to work, a small number will ?test drive? these in a preliminary trial that can then be rolled out to a larger number of hospitals, to find the best way to reduce MRSA and Clostridium difficile through isolation.The two lead researchers in the I-STRAT trial, Barry Cookson and Sheldon Stone, say ?Nowhere in the world has looked at how best to make isolation work. Part of the reason for that is that there are so many difficulties in running a proper trial of this. People think that isolation may be expensive, or that is it hard to provide designated staff. No one is even sure exactly which patients should be isolated, or how we should measure success. This study is going to address these issues, working closely with Trusts, to help them come up with their own interventions to design a feasible ?mini-trial?. If that looks practical, then we could move to a full scale trial which might provide us with some definite answers about the role of isolation in fighting these so-called ?superbugs?