MRSA Infection

Controversies in Hospital Infection Prevention: Myopic consequences

Controversies in Hospital Infection Prevention: Myopic consequences.

The May issue of American Journal of Infection Control has a survey of infection prevention programs in US hospitals assessing the impact of the CMS policy to restrict payment for hospital-acquired central line associated bloodstream infections (CLABSI), catheter associated UTI (CAUTI), and selected surgical site infections. Five hundred hospitals were randomly selected to participate and the response was 64%. While the survey contained some good news, primarily that hospitals were making efforts to get urinary and central venous catheters removed more quickly, 3 disturbing findings were uncovered:

Go to the link above for the whole article

Audit of Staphylococcus aureus bacteraemia management in NHS Tayside and comparison with European Antibiotic Strategies study group international quality standards

Audit of Staphylococcus aureus bacteraemia management in NHS Tayside and comparison with European Antibiotic Strategies study group international quality standards.

Staphylococcus aureus bacteraemia (SAB) remains a significant cause of morbidity and mortality.1 National emphasis on SAB prevention has been successful in reducing the incidence, but there were still >14 000 episodes in the UK in 2007.2 The European Antibiotic Strategies (ABS) study group (http://www.abs-international.eu/index.php?id=1265) proposed SAB management indicators to investigate quality of care and tested these in five European countries.3 Our study is the first in the UK to compare current clinical practice for SAB management against the proposed ABS quality indicators, which are not yet in use in the study hospital.

Controversies in Hospital Infection Prevention: Are contact precautions headed for extinction?

Controversies in Hospital Infection Prevention: Are contact precautions headed for extinction?.

There's an interesting letter in the latest Clinical Infectious Diseases from Dan Morgan and Kathy Kirkland on contact precautions. They surveyed 34 infectious diseases physicians at a meet-the-professor session at the 2011 Infectious Diseases Society of America Meeting. Interestingly, only 38% believed that contact precautions prevent transmission of multidrug resistant organisms, and 74% felt that contact precautions may actually harm patients. The sample size of the survey was small and perhaps there's bias in that the participants had selected to attend a session on contact precautions, but the findings are intriguing

Study: Proactive approach to hospital infections could cut costly readmissions

Study: Proactive approach to hospital infections could cut costly readmissions.

Tracking nearly 140,000 patients admitted to the University of Maryland Medical Center in Baltimore from 2001 to 2008, the team reviewed the number of patients readmitted within one year after discharge, as well as the number of patients with positive cultures for one of three major HAIs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, or Clostridium difficile (C. difficile) more than 48 hours after admission. They identified close to 4,800 patients with positive cultures after more than 48 hours following hospital admission and found that these patients were 40 percent more likely to readmitted to the hospital within a year and 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures.

Is MRSA a hospital-level problem?

Is MRSA a hospital-level problem? | The Center for Disease Dynamics, Economics & Policy.

CDDEP director Ramanan Laxminarayan weighs in on the landscape of hospital infection control in a recent commentary for PNAS.  The commentary is in response to a study by Ke et al that shows how increasing patient sharing leads to decreased heterogeneity of MRSA strains among medical facilities. The evidence points to the conclusion that as long as patients move between facilities, MRSA and other hospital-acquired infections will move with them and will require solutions beyond the individual hospital level.  Active screening and electronic health records could aid the effort, as could incentives for facilities to take part in regionally coordinated infection control programs.

Dirty dentures? Dangerous MRSA may be lurking, dentists say

Vitals - Dirty dentures? Dangerous MRSA may be lurking, dentists say.

Here’s some bad news for the estimated 20 million people in the U.S. who wear full or partial dentures: There’s a good chance your choppers are covered with thin layers of icky, sticky bacteria known as biofilms. Worse, some of the biofilm germs may be bad bugs such as MRSA, or drug-resistant staphylococcus aureus bacteria, which can lurk on the dentures until they’re breathed into the lungs, where experts fear they may cause nasty, hard-to-treat infections. Fortunately, a team of scientists in Brazil has come up with two simple solutions that seem to work: Zap your dentures in the microwave for three minutes, or soak them in a solution of 2 percent chlorhexidine gluconate, a germicidal mouthwash, for 10 minutes.

Infection prevention, control policies not enough to stop MRSA spread

Infection prevention, control policies not enough to stop MRSA spread.

Surveys were administered between March and October 2011; 223 replies were received from infection prevention and control doctors or nurses across 29 European countries. Of the respondents, 105 hospitals had MRSA proportions less than 5%, 47 hospitals had MSRA proportions between 5% and 20%, and 71 hospitals had MRSA proportions great than 20%. More hospitals in the categories with lower MRSA performed daily surveillance of MRSA incidence and also performed root cause analyses to investigate the origin of the infections. No correlation was observed between MRSA prevalence and hospitals that report policies for insertion and maintenance of peripheral and central venous catheters. The presence of policies for removal of peripheral cannulae at 72 hours or presence of IV line care teams did not correlate with MRSA prevalence. However, hospitals that performed assessments on the staff’s ability to insert and maintain these lines had significantly lower MRSA proportions.

MRSA in shared areas - chairs a hot spot

MRSA cases down at Tucson Fire Dept. | KVOA.com | Tucson, Arizona.

MRSA's an antibiotic-resistant bacteria that was found in many Tucson fire houses. Officials counted 26-cases over a period of several years. In 2007, the fire department got help. The Mel and Enid College of Public Health stepped-in and now the fire department's reporting 0 cases of MRSA. Deputy fire chief Ed Nied says, "No one wants to get sick and take that home to their baby, and that's what happened to one of our individuals." Turns out MRSA was mainly found on the couches, and the chairs inside fire stations, all of which have been re upholstered with material that can be wiped down.

How effective is daily chlorhexidine bathing

JSTOR: Infection Control and Hospital Epidemiology, Vol. 33, No. 3 (March 2012), pp. 257-267.

Design. Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies to assess the efficacy of daily bathing with chlorhexidine (CHG) for prevention of healthcare-associated bloodstream infections (BSIs). Setting. Medical, surgical, trauma, and combined medical-surgical intensive care units (ICUs) and long-term acute care hospitals. Participants. Inpatients. Methods. Data on patient population, diagnostic criteria for BSIs, form and concentration of topical CHG, incidence of BSIs, and study design were extracted. Results. One randomized controlled trial and 11 nonrandomized controlled trials reporting a total of 137,392 patient-days met the inclusion criteria; 291 patients in the CHG arm developed a BSI over 67,775 patient-days, compared with 557 patients in the control arm over 69,617 catheter-days. CHG bathing resulted in a reduced incidence of BSIs: the pooled odds ratio using a random-effects model was 0.44 (95% confidence interval, 0.33–0.59; ). Statistical heterogeneity was moderate, with an I2 of 58%. For the subgroup of studies that examined central line–associated BSIs, the odds ratio was 0.40 (95% confidence interval, 0.27–0.59). Conclusions. Daily bathing with CHG reduced the incidence of BSIs, including central line–associated BSIs, among patients in the medical ICU. Further studies are recommended to determine the optimal frequency, method of application, and concentration of CHG as well as the comparative effectiveness of this strategy relative to other preventive measures available for reducing BSIs. Future studies should also examine the efficacy of daily CHG bathing in non-ICU populations at risk for BSI.

Severe MRSA infections associated with epidural injections at an outpatient pain clinic

Severe methicillin-susceptible Staphylococcus aureus infections associated with epidural injections at an outpatient pain clinic.

Background Recent outbreaks in ambulatory care settings have highlighted infection control breaches as risk factors for disease transmission. In May 2009, 3 patients were hospitalized with severe methicillin-susceptible Staphylococcus aureus (MSSA) infections after receiving epidural injections at a West Virginia outpatient pain clinic. Methods We conducted a retrospective cohort study evaluating clinic patients who received injections during a 3-week period. A case was defined as laboratory-confirmed infection or clinical evidence of infection ≤ 14 days after a patient received an injection. Infection control procedures were assessed. MSSA isolates from patient infections and clinic staff nasal swabs were genotyped by using pulsed-field gel electrophoresis. Results Eight (7%) of 110 cohort patients met the case definition; 6 (75%) cases were laboratory confirmed. Eight (12%) of 69 patients who received epidural injections were case patients compared with none of the other 41 patients (P = .02). During procedures, staff use of face masks and preparation of patient skin were suboptimal; epidural injection syringes were reused to access shared medication vials. MSSA isolates from 2 patients and 1 staff member were indistinguishable by pulsed-field gel electrophoresis. Conclusion Infection control breaches likely facilitated MSSA transmission to patients receiving epidural injections. Adhering to correct infection control practices in ambulatory care settings is critical to prevent disease transmission.

MRSA: How one NHS trust cut infection rates by 80%

MRSA: How one NHS trust cut infection rates by 80% | Healthcare Network | Guardian Professional.

One of the key innovations she witnessed during her five days in Baltimore was the use of hydrogen peroxide vapour for decontamination. "When they discharged a patient who had an infection, they would clean the room and then use the hydrogen peroxide vapour to decontaminate it," Wake says. "That was something that we were not doing here in the UK and it really interested me." Johns Hopkins was using the vapour in what Wake describes as a "reactive" way to treat equipment after an infection, but she decided to use the technique "proactively". The trust adopted a system supplied by Johnson and Johnson Medical to apply hydrogen peroxide vapour "across the board in the organisation, whenever we have discharged a patient". Wake emphasises, however, that the vapour is not a substitute for cleaning and that the trust's cleaners have been "incredibly resourceful" in increasing the amount of cleaning of wards and departments.

Liverpool hospital trust cuts infection rates by 80%

BBC News - Liverpool hospital trust cuts infection rates by 80%.

A hospital trust has been named as a centre of excellence in infection prevention after it cut cases of infection by more than 80%. In 2008, the Royal Liverpool and Broadgreen University Hospitals NHS Trust was one of the worst in terms of infection control. Following work on cleaning standards, it has reduced cases of Clostridium difficle by 80.5% and MRSA by 86%. The trust said the reduction had saved about £2.3m.

Four Key Risk Factors for HA-MRSA Infection in ICU

Researchers Find Four Prognostic Variables as Risk Factors for HA-MRSA Infection in ICU.

The researchers concluded that four prognostic variables were found to be risk factors for HA-MRSA infection in ICU: intubation, open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission. Preemptive infection control in patients with these risk factors might effectively decrease HA-MRSA infection. Their research was published in BMC Infectious Diseases.

Record number of patients catch infections in UK hospitals

Record number of patients catch infections in hospitals - Telegraph.

Recorded cases of patients with a “nosocomial condition” – any infection acquired in hospital or a medical environment – also rose by more than a third last year compared with the year before. A large proportion of the patients involved were aged over 75, the figures from the NHS Information Centre show. Illnesses related to such infections led to average stays in hospital last year of 31.1 days. Experts blamed poor hygiene for the dramatic rise in infections, including superbugs MRSA and Clostridium difficile (C. diff) as well as norovirus and E.coli. But the Department of Health dismissed the “misleading” figures, published online, saying that officials have “got better and better at tackling hospital infections”. According to the new figures, supplied by NHS hospitals, the number of patients found by consultants to have hospital-acquired infections rose last year reached a record 42,712.

Vancomycin and cefazolin - a safe prophylactic regimen against MRSA in open fractures

Vancomycin and cefazolin seen as a safe prophylactic regimen against MRSA in open fractures.

Researchers from the University of Colorado School of Medicine in Denver discovered higher rates of methicillin-resistant Staphylococcus aureus in patients with open fractures and that the addition of vancomycin to cefazolin is a safe prophylactic method against the organism. “Staphylococcus aureus is the number one cause of surgical site infection,” Carla C. Saveli, MD, said in her presentation at the 2011 Annual Meeting of the Orthopaedic Trauma Association. “Therefore, it should be the main target for prophylaxis. The current standard of care for patients with open fractures is to administer a first-generation cephalosporin […] from presentation and for 24 to 48 hours after wound closure.” “The benefits of antibiotic prophylaxis in open fractures have been clearly demonstrated in several randomized controlled trials, but the choice of antibiotic remains controversial since the current guidelines do not recommend agents with [methicillin-resistant Staphylococcus aureus] MRSA activity,” the authors wrote in their abstract.

Saving Lives audits: do they improve infection prevention and control practice?

Saving Lives audits: do they improve infection prevention and control practice?.

Aretrospective audit evaluation was conducted to determine whether the introduction of two clinical skills trainers for four months in a district general hospital improved compliance with infection prevention and control practices. Saving Lives (Department of Health, 2010) peripheral venous cannula and urinary catheter high impact intervention audit data were analysed for six months before, four months during and six months after the clinical skills training was implemented for six control wards and seven intervention wards. Findings showed that although the control wards did not improve compliance significantly over the study period, the intervention wards improved compliance with the high impact intervention care bundles studied and that this practice was sustained for six months after the clinical skills training. The findings suggest that education is required to improve clinical skills surrounding cannulation and catheterisation, which can then be sustained by Saving Lives audits to reduce the risk of infection to patients.

Health district looks for funding to control MRSA

Health district looks for funding to control MRSA.

South Shore Health is looking for a little government help to control its MRSA issues. Over recent months, South Shore Regional Hospital has had two outbreaks of antibiotic-resistant bacteria on its fourth-floor medical unit. In the fall, as many as 20 cases of MRSA (methicillin-resistant Staphylococcus aureus) were confirmed. Earlier this month nine patients were reported to have contracted the bacteria on the same unit. Chief executive officer Alice Leverman said additional funding is required to install more handwashing sinks on the unit and replace some furniture. The bacteria can be spread from direct contact. Therefore, infection control has also reviewed handwashing protocol with staff to ensure proper procedures are being followed. "It"s a variety of pieces that we need to focus on and always, if we have an event like that, the important thing is to review what you"re doing and what you could be doing better to ensure that, to the fullest extent possible, you can prevent that," said Ms Leverman.

Room ventilation and the risk of airborne infection

Room ventilation and the risk of airborne infection transmission in 3 health care settings within a large teaching hospital.

Background Room ventilation is a key determinant of airborne disease transmission. Despite this, ventilation guidelines in hospitals are not founded on robust scientific evidence related to the prevention of airborne transmission. Methods We sought to assess the effect of ventilation rates on influenza, tuberculosis, and rhinovirus infection risk within 3 distinct rooms in a major urban hospital: a lung function laboratory, an emergency department negative-pressure isolation room, and an outpatient consultation room. Air-exchange rate measurements were performed in each room using CO2 as a tracer. The model developed by Gammaitoni and Nucci was used to estimate infection risk. Results Current outdoor air-exchange rates in the lung function laboratory and emergency department isolation room limited infection risks to 0.1%-3.6%. Influenza risk for individuals entering an outpatient consultation room after an infectious individual departed ranged from 3.6% to 20.7%, depending on the duration for which each person occupied the room. Conclusion Given the absence of definitive ventilation guidelines for hospitals, air-exchange measurements combined with modeling afford a useful means of assessing, on a case-by-case basis, the suitability of room ventilation for preventing airborne disease transmission.

Prevention ‘too focused on MRSA’ — Irish Medical Times

Prevention ‘too focused on MRSA’ — Irish Medical Times.

Dr Kirsten Schaffer, Chairperson of Strategy for the control of Antimicrobial Resistance in Ireland (SARI) Sub-Committee on the Management of MDROs, who was helping to spearhead efforts to come up with national guidelines to refocus attention and preventive efforts towards all MDROs, said that while HPSC data indicated a decrease in the occurrence of MRSA bloodstream infections (BSIs) in Ireland from 2005 to 2010, it showed a continuous increase in BSIs caused by organisms such as Escherichia coli and Enterococcus faecium and they had now exceeded MRSAs. In 2010, some 304 BSIs due to MRSA were reported versus 446 BSIs due to other MDROs, a significant proportion of which were vancomycin-resistant enterococci (including carbapenem-resistant Enterobacteriaceae).

Increased transmission of MRSA and VRE sparks infection control response

Increased transmission of MRSA and VRE at STEGH - St. Thomas Times-Journal - Ontario, CA.

The St. Thomas Elgin General Hospital (STEGH) through normal monitoring procedures has noted an increase in transmission of VRE and MRSA above normal rates. Following consultation with Elgin St Thomas Public Health (ESPH) Friday afternoon, STEGH declared an outbreak situation on the 2nd surgical floor. These patients are not symptomatic but this bacteria was identified during routine swabs. "We have very strict monitoring measures in place. On a day-to-day basis we know our transmission rate and immediately act upon any trends," explains Brenda Lambert, VP Patient Services. "We are declaring this outbreak in part to raise awareness within the organization and the community of the need for diligent hand washing, and following isolation precautions."