Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T07:11:12.617Z Has data issue: false hasContentIssue false
  • English
  • Français

Sustained Reduction in the Clinical Incidence of Methicillin-Resistant Staphylococcus aureus Colonization or Infection Associated with a Multifaceted Infection Control Intervention

Published online by Cambridge University Press:  02 January 2015

Katherine Ellingson ,
Robert R. Muder ,
Rajiv Jain ,
David Kleinbaum ,
Pei-Jean I. Feng ,
Candace Cunningham ,
Cheryl Squier ,
Jon Lloyd ,
Jonathan Edwards  and
Val Gebski
...Show all authors
Katherine Ellingson*
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Robert R. Muder
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Rajiv Jain
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
David Kleinbaum
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Pei-Jean I. Feng
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Candace Cunningham
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Cheryl Squier
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Jon Lloyd
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Jonathan Edwards
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Val Gebski
Affiliation:
University of Sydney, Camperdown, Australia
John Jernigan
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, 1600 Clifton Road NE, MS A-31, Atlanta, GA 30333 (kellingson@cdc.gov)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To assess the impact and sustainability of a multifaceted intervention to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission implemented in 3 chronologically overlapping phases at 1 hospital.

Design.

Interrupted time-series analyses.

Setting.

A Veterans Affairs hospital in the northeastern United States.

Patients and Participants.

Individuals admitted to acute care units from October 1, 1999, through September 30, 2008. To calculate the monthly clinical incidence of MRSA colonization or infection, the number of MRSA-positive cultures obtained from a clinical site more than 48 hours after admission among patients with no MRSA-positive clinical cultures during the previous year was divided by patient-days at risk. Secondary outcomes included clinical incidence of methicillin-sensitive S. aureus colonization or infection and incidence of MRSA bloodstream infections.

Interventions.

The intervention—implemented in a surgical ward beginning October 2001, in a surgical intensive care unit beginning October 2003, and in all acute care units beginning July 2005—included systems and behavior change strategies to increase adherence to infection control precautions (eg, hand hygiene and active surveillance culturing for MRSA).

Results.

Hospital-wide, the clinical incidence of MRSA colonization or infection decreased after initiation of the intervention in 2001, compared with the period before intervention (P = .002), and decreased by 61% (P < .001) in the 7-year postintervention period. In the postintervention period, the hospital-wide incidence of MRSA bloodstream infection decreased by 50% (P = .02), and the proportion of S. aureus isolates that were methicillin resistant decreased by 30% (P < .001).

Conclusions.

Sustained decreases in hospital-wide clinical incidence of MRSA colonization or infection, incidence of MRSA bloodstream infection, and proportion of S. aureus isolates resistant to methicillin followed implementation of a multifaceted prevention program at one Veterans Affairs hospital. Findings suggest that interventions designed to prevent transmission can impact endemic antimicrobial resistance problems.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 1 , January 2011 , pp. 1 - 8
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L; The Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Department of Health and Human Services. http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed April 21, 2010.Google Scholar
2. Infectious Diseases Society of Ameria. Bad bugs, no drugs. http://www.idsociety.org/10x20.htm. Accessed November 7, 2010.Google Scholar
3.Spellberg, B, Guidos, R, Gilbert, D, et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 2008;46(2):155–164.CrossRefGoogle Scholar
4.Hidron, A, Low, CE, Honig, EG, Blumberg, HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus strain USA300 as a cause of necrotising community-onset pneumonia. Lancet Infect Dis 2009;9(6):384–392.CrossRefGoogle ScholarPubMed
5.Klevens, RM, Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes, R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42(3):389–391.CrossRefGoogle ScholarPubMed
6.Kuehnert, MJ, Hill, HA, Kupronis, BA, Tokars, JI, Solomon, SL, Jernigan, DB. Methicillin-resistant-Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11(6):868–872.CrossRefGoogle ScholarPubMed
7.Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):1763–1771.CrossRefGoogle ScholarPubMed
8.Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16(12):686–696.CrossRefGoogle Scholar
9.Melzer, M, Eykyn, SJ, Gransden, WR, Chinn, S. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus?. A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 2003;37(11):1453–1460.CrossRefGoogle ScholarPubMed
10.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26(2):166–174.CrossRefGoogle ScholarPubMed
11.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36(1):53–59.CrossRefGoogle ScholarPubMed
12.Albrich, WC, Harbarth, S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008;8(5):289–301.CrossRefGoogle ScholarPubMed
13.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43(8):971–978.CrossRefGoogle ScholarPubMed
14.Robksek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409–418.CrossRefGoogle Scholar
15.Burton, DC, Edwards, JR, Horan, TC, Jernigan, JA, Fridkin, SK. Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA 2009;301(7):727–736.CrossRefGoogle ScholarPubMed
16.Muder, RR, Cunningham, C, McCray, E, et al. Implementation of an industrial systems-engineering approach to reduce the incidence of methicillin-resistant Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2008;29(8):702–708.CrossRefGoogle ScholarPubMed
17.Spear, S, Bowen, H. Decoding the DNA of the Toyota Production System. Harv Bus Rev 1999;77:97–106.Google Scholar
18.Lloyd, J, Buscell, P, Lindberg, C. Staff-driven cultural transformation diminishes MRSA. Prevention Strategist 2008;Spring:10–15.Google Scholar
19.Singhal, A, Greiner, K, Buscell, P. Do what you can, with what you have, where you are. Deeper Learning 2007;1(4):1–14. Plexus Institute, http://www.plexusinstitute.org/news-events/show_news.cfm?id=1555&TY=7. Accessed July 31, 2010.Google Scholar
20.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195(3):330–338.CrossRefGoogle ScholarPubMed
21.Cohen, AL, Calfee, D, Fridkin, SK, et al. Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper. Infect Control Hosp Epidemiol 2008;29(10):901–913.CrossRefGoogle ScholarPubMed
22.Shardell, M, Harris, AD, El-Kamary, SS, Furuno, JP, Miller, RR, Perencevich, EN. Statistical analysis and application of quasi experiments to anti-microbial resistance intervention studies. Clin Infect Dis 2007;45(7):901–907Google Scholar
23.Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27(4):299–309.CrossRefGoogle ScholarPubMed
24.Durbin, J, Watson, GS. Testing for serial correlation in least squares regression. II. Biometrika 1951;38(1-2):159–178.CrossRefGoogle ScholarPubMed
25.Harbarth, S, Fankhauser, C, Schrenzel, J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299(10):1149–1157.CrossRefGoogle ScholarPubMed
26.Pujol, M, Pena, C, Pallares, R, et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-suceptible strains. Am J Med 1996;100(5):509–516.CrossRefGoogle Scholar
27.Jernigan, JA, Pullen, AL, Flowers, L, Bell, M, Jarvis, WR. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003;24(6):409–414.CrossRefGoogle ScholarPubMed
28.Gorwitz, RJ, Kruszon-Moran, D, McAllister, SK, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008;197(9):1226–1234.CrossRefGoogle ScholarPubMed
29.Tenover, FC, McAllister, SK, Fosheim, G, et al. Characterization of Staphylococcus aureus isolates from nasal cultures collected from individuals in the United States in 2001 to 2004. J Clin Microbiol 2008;46(9):2837–2841.CrossRefGoogle ScholarPubMed
30.Lipsitch, M, Bergstrom, CT, Levin, BR. The epidemiology of antibiotic resistance in hospitals: paradoxes and prescriptions. Proc Natl Acad Sci USA 2000;97(4):1938–1943.CrossRefGoogle ScholarPubMed
31.Cooper, BS, Medley, GF, Stone, SP, et al. Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 2004;101(27):10223–10228.CrossRefGoogle ScholarPubMed