Selective Use of Intranasal Mupirocin and Chlorhexidine Bathing and the Incidence of Methicillin-ResistantStaphylococcus aureusColonization and Infection Among Intensive Care Unit Patients

2007 ◽  
Vol 28 (10) ◽  
pp. 1155-1161 ◽  
Author(s):  
Glenn Ridenour ◽  
Russell Lampen ◽  
Jeff Federspiel ◽  
Steve Kritchevsky ◽  
Edward Wong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Active Surveillance ◽  
Baseline Period ◽  
Incidence Density ◽  
Surveillance Cultures ◽  
Chlorhexidine Bathing ◽  
Intranasal Mupirocin ◽  
Incident Cases ◽  
Mrsa Colonization

Objective.To determine whether the use of chlorhexidine bathing and intranasal mupirocin therapy among patients colonized with methicillin-resistantStaphylococcus aureus(MRSA) would decrease the incidence of MRSA colonization and infection among intensive care unit (ICU) patients.Methods.After a 9-month baseline period (January 13, 2003, through October 12, 2003) during which all incident cases of MRSA colonization or infection were identified through the use of active-surveillance cultures in a combined medical-coronary ICU, all patients colonized with MRSA were treated with intranasal mupirocin and underwent daily chlorhexidine bathing.Results.After the intervention, incident cases of MRSA colonization or infection decreased 52% (incidence density, 8.45 vs 4.05 cases per 1,000 patient-days;P= .048). All MRSA isolates remained susceptible to chlorhexidine; the overall rate of mupirocin resistance was low (4.4%) among isolates identified by surveillance cultures and did not increase during the intervention period.Conclusions.We conclude that the selective use of intranasal mupirocin and daily chlorhexidine bathing for patients colonized with MRSA reduced the incidence of MRSA colonization and infection and contributed to reductions identified by active-surveillance cultures. This finding suggests that additional strategies to reduce the incidence of MRSA infection and colonization—beyond expanded surveillance—may be needed.

Value of Performing Active Surveillance Cultures on Intensive Care Unit Discharge for Detection of Methicillin-ResistantStaphylococcus aureus

2007 ◽  
Vol 28 (6) ◽  
pp. 666-670 ◽  
Author(s):  
Jon P. Furuno ◽  
Anthony D. Harris ◽  
Marc-Oliver Wright ◽  
David M. Hartley ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Active Surveillance ◽  
Tertiary Care ◽  
Large Percentage ◽  
Care Hospital ◽  
Icu Admission ◽  
Surveillance Cultures ◽  
Icu Discharge ◽  
Mrsa Colonization

Objective.To quantify the value of performing active surveillance cultures for detection of methicillin-resistantStaphylococcus aureus(MRSA) on intensive care unit (ICU) discharge.Design.Prospective cohort study.Setting.Medical ICU (MICU) and surgical ICU (SICU) of a tertiary care hospital.Participants.We analyzed data on adult patients who were admitted to the MICU or SICU between January 17, 2001, and December 31, 2004. All participants had a length of ICU stay of at least 48 hours and had surveillance cultures of anterior nares specimens performed on ICU admission and discharge. Patients who had MRSA-positive clinical cultures in the ICU were excluded.Results.Of 2,918 eligible patients, 178 (6%) were colonized with MRSA on ICU admission, and 65 (2%) acquired MRSA in the ICU and were identified by results of discharge surveillance cultures. Patients with MRSA colonization confirmed by results of discharge cultures spent 853 days in non-ICU wards after ICU discharge, which represented 27% of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.Conclusions.Surveillance cultures of nares specimens collected at ICU discharge identified a large percentage of MRSA-colonized patients who would not have been identified on the basis of results of clinical cultures or admission surveillance cultures alone. Furthermore, these patients were responsible for a large percentage of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.

An Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit

2003 ◽  
Vol 24 (5) ◽  
pp. 317-321 ◽  
Author(s):  
Lisa Saiman ◽  
Alicia Cronquist ◽  
Fann Wu ◽  
Juyan Zhou ◽  
David Rubenstein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Methicillin Resistant ◽  
Children's Hospital ◽  
Surveillance Cultures ◽  
Children’S Hospital ◽  
Incident Cases

AbstractObjective:To describe the epidemiologic and molecular investigations that successfully contained an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal intensive care unit (NICU).Design:Isolates of MRSA were typed by pulsed-field gel electrophoresis (PFGE) and S. aureus protein A (spa).Setting:A level III-IV, 45-bed NICU located in a children's hospital within a medical center.Patients:Incident cases had MRSA isolated from clinical cultures (eg, blood) or surveillance cultures (ie, anterior nares).Interventions:Infected and colonized infants were placed on contact precautions, cohorted, and treated with mupirocin. Surveillance cultures were performed for healthcare workers (HCWs). Colonized HCWs were treated with topical mupirocin and hexachlorophene showers.Results:From January to March 2001, the outbreak strain of MRSA PFGE clone B, was harbored by 13 infants. Three (1.3%) of 235 HCWs were colonized with MRSA. Two HCWs, who rotated between the adult and the pediatric facility, harbored clone C. One HCW, who exclusively worked in the children's hospital, was colonized with clone B. From January 1999 to November 2000, 22 patients hospitalized in the adult facility were infected or colonized with clone B. Spa typing and PFGE yielded concordant results. PFGE clone B was identified as spa type 16, associated with outbreaks in Brazil and Hungary.Conclusions:A possible route of MRSA transmission was elucidated by molecular typing. MRSA appears to have been transferred from our adult facility to our pediatric facility by a rotating HCW. Spa typing allowed comparison of our institution's MRSA strains with previously characterized outbreak clones.

scholarly journals Active Surveillance Cultures for Methicillin‐ResistantStaphylococcus aureusin an Intensive Care Unit

2008 ◽  
Vol 47 (9) ◽  
pp. 1237-1238 ◽  
Author(s):  
Johan H. T. Wagenvoort ◽  
Els I. De Brauwer ◽  
Jo M. Gronenschild ◽  
Hub J. Toenbreker ◽  
Anita M. Schopen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Active Surveillance ◽  
Surveillance Cultures

Outbreak of Methicillin-Resistant Staphylococcus aureus Colonization and Infection in a Neonatal Intensive Care Unit Epidemiologically Linked to a Healthcare Worker With Chronic Otitis

2006 ◽  
Vol 27 (6) ◽  
pp. 581-585 ◽  
Author(s):  
Mary L. Bertin ◽  
Joan Vinski ◽  
Steven Schmitt ◽  
Camille Sabella ◽  
Lara Danziger-Isakov ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Molecular Typing ◽  
Neonatal Intensive Care ◽  
Outbreak Strain ◽  
Methicillin Resistant ◽  
Surveillance Cultures ◽  
Mrsa Colonization

Objective.To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU).Design.Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR).Setting.Level III NICU in a tertiary care center.Participants.Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual.Interventions.Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week.Results.Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU.Conclusion.An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.

scholarly journals Comparison of surveillance and clinical cultures to measure the impact of infection control interventions on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in the hospital

2020 ◽  
pp. 1-5
Author(s):  
Surbhi Leekha ◽  
Lyndsay M. O’Hara ◽  
Alyssa Sbarra ◽  
Shanshan Li ◽  
Anthony D. Harris
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
The United States ◽  
Incidence Density ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Convenience Sample ◽  
Surveillance Cultures ◽  
The Impact

Abstract Objective: To evaluate whether clinical cultures are an appropriate surrogate for surveillance cultures to measure the effect of interventions on the incidence of MRSA and VRE in the hospital. Design: Cross-sectional and quasi-experimental, retrospective analysis Setting and population: Convenience sample of patients admitted between January 1, 2002, and June 31, 2011, to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) of an acute-care hospital in the United States. Interventions: Asynchronously in the MICU and SICU, we introduced (1) universal glove and gown use, (2) bundled intervention to prevent central-line–associated bloodstream infection, and (3) daily chlorhexidine gluconate bathing. Results: We observed a statistically significant correlation between surveillance and clinical culture-based incidence rates of MRSA in the MICU (0.32; P < .001) and the SICU (0.37; P < .001) but not for VRE in either the MICU (0.16, P = .11) or the SICU (0.15; P = .12). For VRE, but not for MRSA, incidence density rates based on surveillance cultures were 2- to 4-fold higher than for clinical cultures. When evaluating the impacts of the interventions, different effect estimates were noted for universal glove and gown use on MRSA acquisition in MICU, and for VRE acquisition in both the MICU and the SICU based on surveillance versus clinical cultures. Conclusions: For multidrug-resistant organism acquisition, surveillance cultures should be used when feasible because clinical cultures may not be an appropriate surrogate. Clinical or surveillance-based end points for infection control interventions should reflect the conceptual model from colonization to infection and where an intervention might have an effect, rather than considering them interchangeable.

scholarly journals Cost-Effectiveness of Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in an Intensive Care Unit

2015 ◽  
Vol 36 (1) ◽  
pp. 17-27 ◽  
Author(s):  
Courtney A. Gidengil ◽  
Charlene Gay ◽  
Susan S. Huang ◽  
Richard Platt ◽  
Deborah Yokoe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Cost Effectiveness ◽  
Active Surveillance ◽  
Chlorhexidine Gluconate ◽  
Standard Precautions ◽  
Surveillance Cultures ◽  
Mrsa Infection ◽  
Mrsa Colonization ◽  
Gluconate Baths

OBJECTIVETo create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection.DESIGNCost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection.PATIENTS AND SETTINGHypothetical cohort of 10,000 adult patients admitted to a US intensive care unit.METHODSWe compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted.RESULTSA total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy.CONCLUSIONSUniversal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.Infect Control Hosp Epidemiol 2015;36(1): 17–27

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