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DNA Typing and Control of Methicillin-Resistant Staphylococcus aureus at Two Affiliated Hospitals

Published online by Cambridge University Press:  02 January 2015

Alan I. Hartstein ,
Ann M. LeMonte  and
Pamela K.L. Iwamoto
Alan I. Hartstein*
Affiliation:
Division of Infectious Diseases and the Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana Infection Control/Epidemiology Laboratory, Indiana University Medical Center, Indianapolis, Indiana Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana
Ann M. LeMonte
Affiliation:
Infection Control/Epidemiology Laboratory, Indiana University Medical Center, Indianapolis, Indiana
Pamela K.L. Iwamoto
Affiliation:
Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana
*
Department of Infection Control/Epidemiology, Wishard Memorial Hospital, 1001 W 10th St, Ott Bldg 211, Indianapolis, IN 46202
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Abstract

Objective:

To describe control of endemic and outbreak-related methicillin-resistant Staphylococcus aureus (MRSA) at two affiliated hospitals.

Design:

Prospective surveillance of patients with MRSA. Disposable gloves were used by all staff having direct contact with the affected patient or his immediate environment, and patient isolates were typed by pulsedfield gel electrophoresis (PFGE) of genomic DNA. Surveillance and PFGE typing were used concurrently to identify possible nosocomial outbreaks, confirm or refute cross-infection, and support a need for additional outbreak control interventions.

Setting:

A university hospital (Hospital A) and a university-affiliated public hospital (Hospital B).

Participants:

Patients with MRSA colonization or infection over an 18-month interval (June 1993-November 1994).

Intervention:

Proper handwashing and gloving practices were reemphasized with staff following confirmation of outbreaks.

Results:

Hospital A had 60 community-acquired and 48 nosocomial cases of MRSA. Two small outbreaks (affecting a total of seven patients) and two pseudo-outbreaks were identified. Hospital B had 36 community-acquired and 22 nosocomial cases of MRSA. Only one outbreak affecting five patients occurred. All outbreaks ended shortly after staff meetings that emphasized ongoing and extremely careful handwashing and gloving when caring for identified patients. The majority of nosocomial cases at both hospitals were not related epidemiologically or had isolates with unique PFGE types. Pseudo-outbreaks were confirmed by demonstrating that isolates from epidemiologically related cases (by time and clinical service or hospital unit) had different PFGE types. Hospital A cases had 39 different PFGE types, and Hospital B cases had 31 different PFGE types.

Conclusion:

MRSA in hospitals, including outbreaks identified by prospective surveillance and confirmed by PFGE typing, can be controlled by minimal special precautions and interventions. This is possible despite the continuous admission of patients with MRSA from the community. PFGE typing is useful to confirm outbreaks and pseudo-outbreaks, demonstrate differences among epidemiologically unrelated isolates, and substantiate the efficacy of MRSA control programs within hospitals.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 1 , January 1997 , pp. 42 - 48
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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