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
| Autor: | Juan Gálvez, Lorena López-Cerero, Antonio B. Millán, M. Dolores del Toro, Lola García, E. Ramirez, C. Velasco, Carmen Lupión, Miguel A. Muniain, Jesús Rodríguez-Baño, Álvaro Pascual |
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| Přispěvatelé: | [Rodríguez-Baño,J, García,L, Lupión,C, Muniain,MA, Gálvez,J, del Toro,MD, Millán,AB] Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena. [Ramírez,E, López-Cerero,L, Pascual,A] Servicio de Microbiología, Hospital Universitario Virgen Macarena. [Rodríguez-Baño,J, Gálvez,J] Departamento de Medicina, Universidad de Sevilla. Sevilla, Spain. [Velaco,C, Pascual,A] Departamento de Microbiología, Universidad de Sevilla. Sevilla, Spain., Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III–Fondo Europeo de Desarrollo Regional, Spanish Network for theResearch in Infectious Diseases (grant REIPI RD06/0008), Fondo de Investigación Sanitaria (grant PI051019)., Universidad de Sevilla. Departamento de Medicina., Universidad de Sevilla. Departamento de Microbiología |
| Rok vydání: | 2010 |
| Předmět: |
Microbiology (medical)
Methicillin-Resistant Staphylococcus aureus medicine.medical_specialty Staphylococcus aureus Patients Endemic Diseases Epidemiology Health Personnel Psychological intervention Bacteremia medicine.disease_cause Hospitals University Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Health Surveys::Population Surveillance [Medical Subject Headings] Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Program Evaluation [Medical Subject Headings] Health care medicine Humans In patient Intensive care medicine Workers Organisms::Bacteria::Endospore-Forming Bacteria::Gram-Positive Endospore-Forming Bacteria::Gram-Positive Endospore-Forming Rods::Staphylococcaceae::Staphylococcus::Staphylococcus aureus::Methicillin-Resistant Staphylococcus aureus [Medical Subject Headings] Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Staphylococcal Infections [Medical Subject Headings] Named Groups::Persons::Patients::Inpatients [Medical Subject Headings] Cross Infection Infection Control Inpatients business.industry Public health Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Bacteremia [Medical Subject Headings] Staphylococcus aureus Resistente a Meticilina Staphylococcal Infections bacterial infections and mycoses Methicillin-resistant Staphylococcus aureus Electrophoresis Gel Pulsed-Field Health Care::Health Care Facilities Manpower and Services::Health Personnel::Infection Control Practitioners [Medical Subject Headings] Infectious Diseases Contact precautions Health Care::Environment and Public Health::Public Health::Endemic Diseases [Medical Subject Headings] Spain Population Surveillance Emergency medicine Pacientes Trabajadores business Long term control Program Evaluation |
| Zdroj: | idUS. Depósito de Investigación de la Universidad de Sevilla instname |
| ISSN: | 1559-6834 0195-9417 |
| Popis: | Objective.To evaluate the long-term impact of successive interventions on rates of methicillin-resistantStaphylococcus 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-susceptibleS. aureusdid 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. |
| Databáze: | OpenAIRE |
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