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Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Jesus Jesús Rodríguez-Baño ,
Lola García ,
Encarnación Ramírez ,
Carmen Lupión ,
Miguel A. Muniain ,
Carmen Velasco ,
Juan Gálvez ,
M. Dolores del Toro ,
Antonio B. Millán  and
Lorena López-Cerero
...Show all authors
Jesus Jesús Rodríguez-Baño*
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain Hospital Universitario Virgen Macarena, and the Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
Lola García
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain
Encarnación Ramírez
Affiliation:
Servicio de Microbiología, Universidad de Sevilla, Sevilla, Spain
Miguel A. Muniain
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain Hospital Universitario Virgen Macarena, and the Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
Carmen Velasco
Affiliation:
Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
Juan Gálvez
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain Hospital Universitario Virgen Macarena, and the Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
M. Dolores del Toro
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain
Antonio B. Millán
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain
Lorena López-Cerero
Affiliation:
Servicio de Microbiología, Universidad de Sevilla, Sevilla, Spain Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
Alvaro Pascual
Affiliation:
Servicio de Microbiología, Universidad de Sevilla, Sevilla, Spain Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
*
Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Avda Dr Fedriani 3, Sevilla 41009, Spain (jesusrb@us.es)
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Abstract

Objective.

To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation.

Design.

Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis.

Setting.

A 950-bed teaching hospital in Seville, Spain.

Patients.

All patients admitted to the hospital during the period from 1995 through 2008.

Methods.

Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers.

Results.

Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care.

Conclusion.

Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 8 , August 2010 , pp. 786 - 795
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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