Researchers outline ways to control MRSA in hospitals

Mar 22, 2010 (CIDRAP News) – Healthcare-associated infections in hospitals, including methicillin-resistant Staphylococcus aureus (MRSA), can be controlled through a variety of strategies that can be tuned to local and national systems, according to research presented this past weekend.

Researchers speaking at the Fifth Decennial International Conference on Healthcare-Associated Infections, held in Atlanta, described successful campaigns to curb healthcare-associated infections (HAIs) that relied on mandatory public reporting of infection rates and also on aggressive infection-control practices.

Separately, a group of community hospitals in the southeastern United States reported that MRSA is no longer their most challenging HAI, having been surpassed by Clostridium difficile.

In one set of research, the French national infection-control program found that requiring healthcare facilities throughout the country to report their rates of HAIs in a public national program produced significant drops in infection rates.

The mandatory-reporting program was part of a broader HAI-control effort that included appointing local and regional infection-control teams, creating antibiotic-stewardship committees, adopting guidelines for preventing surgical-site infections, and working to educate patients.

In a 2006 survey that covered more than 2,300 hospitals and other facilities, the program demonstrated that all HAIs had decreased by 12% since 2001, and surgical-site infections had fallen 38%. Over that period, HAIs caused by MRSA fell by 40%.

In a second project, Virginia Commonwealth University Medical Center forced down its rate of MRSA HAIs by instituting broad infection-control measures that included aggressive reinforcement of hand hygiene, daily antiseptic baths for ICU patients, "bare below the elbows" recommendations for eliminating germ-carrying clothing and jewelry, and several "bundles" of specific actions to be performed when placing central-line catheters and caring for patients on ventilators.

The multi-part program, which was rolled out in steps starting in 2004, reduced MRSA central line-associated bloodstream infections by 91%, MRSA catheter-associated urinary tract infections by 62%, and MRSA ventilator-associated pneumonia by 92%. In one 3-month period, the third quarter of 2009, there were no MRSA device-associated infections in any of VCU's eight intensive-care units.

The VCU team underlined in its presentation that the hospital reduced infections without using active surveillance and testing, the practice of checking all high-risk patients for MRSA colonization on admission to the hospital or to a particular unit and placing them in isolation until they are deemed clear of the organism. (Active surveillance and testing is in use in some hospitals in France.)

Also at the meeting, the Duke Infection Control Outreach Network announced results of surveillance from 30 community hospitals in North Carolina, in which they found that the leading cause of HAIs in their institutions was not MRSA but C difficile, which is more difficult to control because it forms spores that persist in the environment and resist many cleaning regimens. HAIs caused by C difficile were as common as bloodstream infections and more common than HAIs caused only by MRSA, the group said.

May-Michelangeli L, et al. Nosocomial infections control in France: the 2005-2008 national program Presented at the Fifth Decennial International Conference on Healthcare-Associated Infections, Mar 20, 2010 [Abstract]

Edmond M, et al. The demise of MRSA at an academic medical center. Presented at the Fifth Decennial International Conference on Healthcare-Associated Infections, Mar 19, 2010 [Abstract]

Miller BA, et al. The impact of hospital-onset healthcare facility associated (HO-HCFA) Clostridium difficile infection (CDI) in community hospitals: surpassing methicillin-resistant Staphylococcus aureus (MRSA) as the new superbug. Presented at the Fifth Decennial International Conference on Healthcare-Associated Infections, Mar 20, 2010 [Abstract]

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