Abstract
ObjectiveTo control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in resource-limited healthcare setting with high endemicity.MethodsThree phases of infection control interventions were implemented in a University-affiliated hospital between 1-January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per-1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model). Usage density of broad-spectrum antibiotics was monitored.ResultsDuring the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3%) were hospital-acquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001), 30.4% (p<0.001), and 19.6% (p = 0.040), while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001), 24.1% (p<0.001), and 21.9% (p = 0.041) respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1) to 168.99 per 1000 patient-days (phase 3).ConclusionsNosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing for MRSA-positive despite an increasing consumption of broad-spectrum antibiotics.
Highlights
The control of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in endemic areas of Asia, Europe, and North America [1,2,3,4] has demonstrated various degree of success with the implementation of active surveillance culture, isolation of MRSA-colonized patients, hand hygiene practice, environmental cleanliness, targeted or universal decolonization, and antimicrobial stewardship program
Our hospital-wide MRSA control program has to depend on the use of hand hygiene campaign [8], which has been associated with reduction of MRSA transmission [9], and contact precautions without single room isolation facility
Our study period was divided into three phases: (i) phase 1– baseline observation period from 1 January 2004 to 31 December 2007; (ii) phase 2– launch of the first intervention from 1 January 2008 to 31 December 2009), and (iii) phase 3– launch of the second intervention from 1 January 2010 to 31 December 2012
Summary
The control of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in endemic areas of Asia, Europe, and North America [1,2,3,4] has demonstrated various degree of success with the implementation of active surveillance culture, isolation of MRSA-colonized patients, hand hygiene practice, environmental cleanliness, targeted or universal decolonization, and antimicrobial stewardship program. The control of MRSA in highly endemic healthcare setting is more challenging where resources are limited and isolation facilities are scarce. Our hospital-wide MRSA control program has to depend on the use of hand hygiene campaign [8], which has been associated with reduction of MRSA transmission [9], and contact precautions without single room isolation facility
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