Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-14T04:22:28.711Z Has data issue: false hasContentIssue false
  • English
  • Français

Control of Methicillin-Resistant Staphylococcus Aureus in a Hospital and an Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Alan I. Hartstein ,
Mark A. Denny ,
Virginia H. Morthland ,
Ann M. LeMonte  and
Michael A. Pfaller
Alan I. Hartstein*
Affiliation:
Division of Infectious Diseases and Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana Department of Infection Control/ Epidemiology, Indiana University Medical Center, Indianapolis, Indiana Infection Control/Epidemiology Laboratory, Indiana University Medical Center, Indianapolis, Indiana
Mark A. Denny
Affiliation:
Department of Infection Control/ Epidemiology, Indiana University Medical Center, Indianapolis, Indiana
Virginia H. Morthland
Affiliation:
Department of Pathology, Oregon Health Sciences University, Portland, Oregon
Ann M. LeMonte
Affiliation:
Infection Control/Epidemiology Laboratory, Indiana University Medical Center, Indianapolis, Indiana
Michael A. Pfaller
Affiliation:
Department of Pathology, Oregon Health Sciences University, Portland, Oregon
*
Department of Infection Control/Epidemiology, Wishard Memorial Hospital, 1001 W. 10th St., Ott Bldg. 211, Indiana, IN 46202
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe methicillin-resistant Staphylococcus aureus (MRSA) control in a hospital, including a surgical intensive care unit (SICU) outbreak.

Design:

Prospective surveillance of newly identified patients with MRSA. Barrier isolation (disposable gloves for direct contact with patient or immediate environment) was used for the routine care of hospitalized MRSA patients as of October 1991. Begirming in 1992, MRSA isolates were typed by restriction endonuclease enzyme analysis of plasmid DNA (REAP) and/or pulsed-field gel electrophoresis of genomic DNA (PFGE). Surveillance information and MRSA typing were used concurrently to identify nosocomial case clustering, confirm cross-infection, and support a need for additional outbreak control interventions.

Setting:

University-affiliated public hospital.

Participants:

Patients with newly identified MRSA colonization or infection from 1991 through 1993 and epidemiologically associated staff providing care to eight SICU patients in an outbreak.

Interventions:

Barrier isolation for affected and unaffected patients in and admitted to the SICU institution when the outbreak was identified and cross-infection confirmed. Anterior nares cultures of staff in contact with outbreak cases for detection of MRSA colonization.

Results:

Fifty-six hospitalized patients with community-acquired MRSA and 80 patients with nosocomial MRSA colonization or infection were identified during the 3 years. After the introduction of barrier isolation, the annual frequency of new nosocomial MRSA cases decreased and only one outbreak (eight cases in the SICU) caused by type-related isolates occurred, The other 35 nosocomial cases of MRSA during 1992 and 1993 were not epidemiologically related or were caused by isolates with different types. The SICU outbreak ended after instituting barrier isolation for all patients (with and without MRSA) in and admitted to the unit. Six colonized SICU staff were identified. All outbreak cases had identical or related MRSA types by PFGE and REAP. Staff isolates were different from case isolates by typing, and staff were not restricted and not given treatment for colonization. After more than 6 months of follow up, no further outbreaks of MRSA in the SICU or elsewhere in the hospital occurred despite returning to barrier isolation for affected patients only.

Conclusion:

MRSA in hospitals and outbreaks of MRSA in ICUs can be controlled by surveillance and minimal barrier interventions. REAP or PFGE typing of MRSA can be used to support or refute the presence of cross-transmission. Typing also may be helpful when planning and assessing the effectiveness of interventions directed at endemic, as well as outbreak, MRSA control.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 7 , July 1995 , pp. 405 - 411
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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. Preheim, LC, Rimland, D, Bittner, MI Methicillin-resistant Staphylococcus aureus in Veterans Administration Medical Centers. Infect Control 1987;8:191–194.Google Scholar
2. Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1990; 11:639–642.CrossRefGoogle ScholarPubMed
3. Panlilio, AL, Culver, DH, Gaynes, RP, et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582–586.Google Scholar
4. Linnemann, CC, Moore, P Staneck, J, Pfaller, MA. Re-emergence of epidemic methicillin-resistant Staphylococcus aureus in a general hospital associated with changing staphylococcal strains. Am J Med 1991;91(suppl 3B):238S–244S.Google Scholar
5. Mylotte, JM, Karuza, J, Bentley, DW. Methicillin-resistant Staphylococcus aureus: a questionnaire survey of 75 long term care facilities in western New York. Infect Control Hosp Epidemiol 1992;13:711–718.CrossRefGoogle ScholarPubMed
6. Layton, M, Hierholzer, W, Patterson, JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital. Infect Control Hosp Epidemiol 1993;13:763.Google Scholar
7. Rimland, D, Killum, E, Roberson, B. Secular trends of infections due to methicillin-resistant Staphylococcus aureus at the Atlanta VA Medical Center. Infect Control Hosp Epidemiol 1993;13:764.Google Scholar
8. Trilla, A, Nettleman, MD, Hollis, RJ, Fredrickson, M, Wenzel, RP Pfaller, MA. Restriction endonuclease analysis of plasmid DNA from methicillin-resistant Staphylococcus aureus; clinical application over a three-year period. Infect Control Hosp Epidemiol 1993;14:29–35.Google Scholar
9. Mulligan, ME, Arbeit, RD. Epidemiologic and clinical utility of typing systems for differentiating among strains of methicillin-resistant Staphylo-coccus aureus. Infect Control Hosp Epidemiol 1991;12:2@28.CrossRefGoogle Scholar
10. Pfaller, MA, Wakefield, DS, Hollis, R, et al. The clinical microbiology laboratory as an aid in infection control. The application of molecular techniques in epidemiologic studies of methicillin-resistant Staphylococcus aureus . Diagn Microbiol Infect Dis 1991;14:209–217.CrossRefGoogle ScholarPubMed
11. Tenover, FC, Arbeit, R, Archer, G, et al. Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus . J Clin Microbiol 1994;32:407–415.CrossRefGoogle ScholarPubMed
12. Garner, JS. Simmons, BE Guideline for isolation precautions in hospital. In: Guidelines for Prevention and Control of Nosocomia1 Infections. Atlanta, GA: Centers for Disease Control and Prevention; 1983:1–24.Google Scholar
13. Hartstein, AI, Morthland, VH, Eng, S, Archer, GL, Schoenknecht, FD, Rashad, AL. Restriction enzyme analysis of plasmid DNA and bacteriophage typing of paired Staphylococcus aureus blood culture isolates. J Clin Microbiol 1989;27:1874–1879.CrossRefGoogle ScholarPubMed
14. Back, NA, Linnemann, CC, Pfaller, MA, Staneck, JL, Morthland, V. Recurrent epidemics caused by a single strain of erythromycin-resistant Staphylococcus aureus . JAMA 1993;270:1329–1333.Google Scholar
15. Dice, LR Measures of the amount of ecologic association between species. Ecology 1945;26:297–302.Google Scholar
16. Boyce, JM. Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 1991:12:4& 54.Google Scholar
17. Crossley, KB, Thurn, JR. Control measures for MRSA-can the cost be reduced? In: Cafferkey, MT, ed. Methicillin-resistant Staphylococcus aureus. New York, NY: Marcel Dekker, Inc; 1992:187–196.Google Scholar
18. Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, II: epidemiologic studies. J Infect Dis 1979;139:280–287.CrossRefGoogle ScholarPubMed
19. Peacock, JE Jr, Marsik, FJ, Wenzel, RP Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93:526–532.Google Scholar
20. Thompson, RL, Cabezudo, I, Wenzel, RP Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309–317.Google Scholar
21. Wenzel, RP Nettleman, MD, Jones, RN, Pfaller, MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(suppl 3B):221S–227S.Google Scholar
22. Simmons, B, Bryant, J, Neiman, K, Spencer, L, Arheart, K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589–594,CrossRefGoogle ScholarPubMed
23. Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725–737.CrossRefGoogle ScholarPubMed
24. Ribner, BS, Landry, MN. Gholson, GL. Strict versus modified isolation for prevention of nosocomial transmission of methicillin-resistant Staphylococcus aureus . Infect Control 1986:7:317–320.Google Scholar
25. Guiguet, M, Rekacewicz, C, Leclercq, B, Brun, Y, Escudier, B, Andermont, A. Effectiveness of simple measures to control an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections in an intensive care unit. Infect Control Hosp Epidemiol 1990;11:23-26.CrossRefGoogle Scholar
26. Cohen, SH, Monta, MM, Bradford, M. A seven year experience with methicillin-resistant Staphylococcus aureus . Am J Med 1991;31 (suppl 3B):233S–237S.Google Scholar
27. Strausbaugh, LJ, Jacobson, C, Yost, T. Methicillin-resistant Staphylococcus aureus in a nursing home and affiliated hospital: a four-year perspective. Infect Control Hosp Epidemiol 1993;14:331-336.Google Scholar
28. Lynch, P Jackson, MM, Cummings, MJ, Stamm, WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;107:243–246.Google Scholar
29. Rimland, D, Roberson, B. Gastrointestinal carriage of methicillin-resistant Staphylococcus aureus . J Clin Microbiol 1986;24:137–138.CrossRefGoogle ScholarPubMed
30. Walsh, TJ. Vlahov, D, Hansen, SL, et al. Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus . Infect Control 1987;87:7–14.Google Scholar
31. Rao, N, Jacobs, S, Joyce, L. Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hosp Epidemiol 1988;9:255–260.CrossRefGoogle Scholar
32. Department of Health and Human Services, Centers for Disease Control and Prevention. Draft guideline for isolation precautions in hospitals. Federal Register 1994;59(214):55552–55570.Google Scholar
33. Mulligan, ME, Murray-Leisure, KA, Ribner, BS. et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.Google Scholar
34. Boyce, JM, Jackson, MM, Pugliese, G, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994:15:105–113.CrossRefGoogle ScholarPubMed
35. Mulligan, ME, Arbeit, RD. Molecular epidemiology: application of contemporary techniques to the typing of microorganisms. Clin Infect Dis 1993;17:153–164.Google Scholar
36. Klein, BS, Perloff, WH, Maki, DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:1714–1721.Google Scholar
37. Stamm, AM, Long, MN, Belcher, B. Prospective, randomized trial of barrier isolation versus universal precautions during medical intensive care (letter). Am J Infect Control 1993;21:163.Google Scholar
38. Weinstein, RA. Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med 1991;91(suppl 3B):179S–184S.Google Scholar
39. Chetchotisakd, P, Phelps, CL, Hartstein AL Assessment of bacterial cross-transmission as a cause of infections in patients in intensive care units. Clin Infect Dis 1994;18:929–937.CrossRefGoogle Scholar
40. Pfaller, MA. Microbiology: the role of the clinical laboratory in hospital epidemiology and infection control. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Baltimore, MD: Williams and Wilkins; 1993:385–405.Google Scholar
41. Goering, RV Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595-600.Google Scholar
42. Pfaller, MA. The use of molecular techniques for epidemiologic typing of Candida species. Curr Top Med Mycol 1992;4:43-63.Google Scholar
43. Girardin, H, Sarfati, J, Traore, F. Dupouy Carnet, J, Derouin, F; Latge, JR Molecular epidemiology of nosocomial invasive aspergillosis. J Clin Microbiol 1994;32:684–690.CrossRefGoogle ScholarPubMed
44. Peterson, LR, Petzel, RA, Clabots, CR, Fasching, CE, Gerding, DN. Medical technologists using molecular epidemiology as part of the infection control team. Diagn Microbiol Infect Dis 1993;16:303–311.CrossRefGoogle ScholarPubMed