Do Infection Control Measures Work for Methicillin-ResistantStaphylococcus aureus?

AbstractObjective:To review evidence regarding the effectiveness of control measures in reducing transmission of methicillin-resistantStaphylococcus aureus(MRSA) in hospitals.Design:Literature review and surveillance cultures of hospitalized patients at high risk for MRSA colonization or infection.Setting:A 500-bed, university-affiliated, community teaching hospital.Results:The percentage of nosocomialS. aureusinfections caused by MRSA increased significantly between 1982 and 2002, despite the use of various isolation and barrier precaution policies. The apparent ineffectiveness of control measures may be due to several factors including the failure to identify patients colonized with MRSA For example, cultures of stool specimens submitted forClostridium difficiletoxin assays at one hospital found that 12% of patients had MRSA in their stool, and 41% of patients with unrecognized colonization were cared for without using barrier precautions. Other factors include the use of barrier precaution strategies that do not account for multiple reservoirs of MRSA, poor adherence of healthcare workers (HCWs) to recommended barrier precautions and handwashing, failure to identify and treat HCWs responsible for transmitting MRSA, and importation of MRSA by patients admitted from other facilities. Control programs that include active surveillance cultures (ASCs) of high-risk patients and use of barrier precautions have reduced MRSA prevalence rates and have been cost-effective. Using a staged approach to implementing ASCs can minimize logistic problems.Conclusion:MRSA control programs are effective if they include ASCs of high-risk patients, use of barrier precautions when caring for colonized or infected patients, hand hygiene, and treating HCWs implicated in MRSA transmission.

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Screening High-Risk Patients for Methicillin-ResistantStaphylococcus Aureuson Admission to the Hospital Is It Cost Effective?

Infection Control and Hospital Epidemiology ◽

10.1086/501655 ◽

1999 ◽

Vol 20 (7) ◽

pp. 473-477 ◽

Cited By ~ 137

Author(s):

Giuseppe Papia ◽

Marie Louie ◽

Arnold Tralla ◽

Claudette Johnson ◽

Veronica Collins ◽

...

Keyword(s):

Nursing Home ◽

High Risk ◽

Infection Control ◽

Control Measures ◽

Care Hospital ◽

High Risk Patients ◽

Infection Control Measures ◽

Risk Patients ◽

Nursing Costs ◽

Mrsa Colonization

Objectives:To determine the cost-effectiveness of a policy of screening high-risk patients for methicillin-resistantStaphylococcus aureus(MRSA) colonization on admission to hospital.Setting:980-bed university-affiliated tertiary-care hospital.Patients:Between June 1996 and May 1997, patients directly transferred from another hospital or nursing home, or who had been hospitalized in the previous 3 months, were screened for MRSA within 72 hours of hospital admission.Design:Nasal, perineal, and wound swabs were obtained for MRSA screening using standard laboratory methods. Laboratory and nursing costs associated with screening patients for MRSA on admission to hospital were calculated. The costs associated with the implementation of recommended infection control measures for patients with MRSA also were determined.Results:3,673 specimens were obtained from 1,743 patients. MRSA was found on admission in 23 patients (1.3%), representing 36% of the 64 patients with MRSA identified in the hospital during the year. MRSA-colonized patients were more likely to have been transferred from a nursing home (odds ratio [OR], 6.4;P=.04) or to have had a previous history of MRSA colonization (OR, 13.1;P=.05). Laboratory and nursing costs were found to be $8.34 per specimen, for a total cost of $30,632 during the year. The average cost of implementing recommended infection control measures for patients colonized with MRSA was approximately $5,235 per patient.Conclusion:If early identification of MRSA in colonized patients prevents nosocomial transmission of the organism to as few as six new patients, the screening program would save money.

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530. Sequential Screening of High-Risk Patients for Carbapenemase-Producing Enterobacteriaceae Colonization

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.599 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S255-S255

Author(s):

Elizabeth Brodkin ◽

Katy Short ◽

Dale Purych

Keyword(s):

Risk Factors ◽

High Risk ◽

Control Measures ◽

Nosocomial Transmission ◽

High Risk Patients ◽

Recent Exposure ◽

Sequential Screening ◽

Negative Results ◽

Infection Control Measures ◽

Risk Patients

Abstract Background Early identification of patients colonized with carbapenemase-producing Enterobacteriaceae (CPE) facilitates the implementation of appropriate infection control measures and reduces nosocomial transmission. Sequential screening for CPE colonization of close contacts of known cases to confirm initial negative results is recommended. Fraser Health (FH) expanded sequential screening to patients with recent exposure to other risk factors following the identification of CPE in patients who initially screened negative. Methods FH screens patients for CPE who report healthcare outside of Canada or travel to endemic countries within the previous 12 months. Patients remain on contact precautions and are re-screened 7 and 21 days after the last known exposure date. We reviewed CPE cases with foreign healthcare or travel to endemic countries who screened negative on admission but subsequently screened positive within 30 days. Patients without confirmation of colonization through a rectal screen or possible exposure to a current nosocomial source were excluded. Whole-genome sequencing results were examined to confirm foreign healthcare or travel as the likely source of acquisition. Medical records were reviewed to obtain patient history and clinical details. Results Between November 2015 and January 2019, 21 patients had a positive CPE screen within 30 days of a negative screen, with no known CPE exposures during that time. The median time between the last date of known exposure and positive CPE screen was 20 days (range: 7–77 days). Twelve (57%) cases were hospitalized outside of Canada, 8 (38%) reported other foreign healthcare encounters, and 1 (5%) had no reported healthcare outside of Canada but had traveled to an endemic country. Sixteen (71%) cases received antibiotics prior to the positive CPE screen. Conclusion Patients with unrecognized CPE colonization are a source for nosocomial transmission. Patients screening negative for CPE with recent exposure to risk factors other than contact with a known case may screen positive at a later date. This may be due to higher colonization levels or antibiotic selection pressures. Consideration should be given to sequential CPE screening of high-risk patients based on the last day of exposure. Disclosures All authors: No reported disclosures.

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CABG cost effective in high-risk patients with coronary disease

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-018-5125-6 ◽

2018 ◽

Vol 808 (1) ◽

pp. 10-10

Keyword(s):

High Risk ◽

Coronary Disease ◽

Cost Effective ◽

High Risk Patients ◽

Risk Patients

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Infection Control in a Country with Annual Inflation of 3,600%

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700007359 ◽

1995 ◽

Vol 16 (3) ◽

pp. 175-178

Author(s):

Sergio B. Wey

Keyword(s):

Infection Control ◽

Administrative Support ◽

Cost Effective ◽

Control Measures ◽

Single Factor ◽

Control Programs ◽

Infection Control Rate ◽

Infection Control Measures ◽

Training Courses ◽

Budget Shortfalls

AbstractThe economic crisis that has been seen worldwide affects developing countries such as Brazil even more severely. Worsening budget shortfalls for the healthcare system progressively threaten patient care. Infection control programs also are affected, and basic preventive policies are not implemented. Infection control practitioners face lack of equipment and poor microbiological support. In contrast, the motivation of the infection control people can be maintained through training courses, conferences, and meetings. Administrative support may be the most important single factor determining success in decreasing the infection control rate and should be (but is not always) provided, given that several infection control measures are cost effective.

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