Screen and clean to beat MRSA: success story from The Netherlands

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) was first reported in 1961, less than 1 year after the introduction of methicillin. An increase in the problem has been observed in Europe and the USA since the 1970s. In most countries the percentage of MRSA in hospitals is now between 20–75%. Although there is high MRSA prevalence in surrounding countries in Europe like Belgium, UK and Germany, for more than 20 years the Dutch healthcare system has been able to keep the number of MRSA cases in the Netherlands extremely low (0.7% in 2008). The official Dutch MRSA guidelines from the national Working Party of Infection Prevention (WIP) have been implemented in every healthcare setting. To ensure the success of such a policy, it is important that all hospitals in the country comply with the guidelines. The most important preventive measure against MRSA is the prudent and restrictive use of antibiotics. An effective infection prevention program in every hospital is the second preventive success factor. Many Dutch laboratories for microbiology take part in the European Antimicrobial Resistance Surveillance System (EARSS), a European network of national surveillance systems, providing reference data on antimicrobial resistance. Moreover, most Dutch hospitals take part in the Dutch national surveillance network PREZIES (Dutch acronym for ‘prevention of healthcare-associated infections through surveillance’), to gain insight into the frequency of healthcare-associated infections and to take part in the national control of basic hygiene. Basic hygiene is part of regular infection prevention policy and includes disinfecting hands with hand alcohol and mechanical cleaning and disinfecting of nursing and medical devices as much as possible. The preventive strategy is called the ‘Search and Destroy’ policy. This means that every patient and all healthcare workers (HCWs) who are suspected for MRSA must be screened for MRSA. The guidelines have been written for identification into four risk groups. Most colonised patients and colonised HCWs do not develop infections; however, they can transmit MRSA to patients and contaminate the environment. To ‘Search’ MRSA, swabs have to be taken from the perineum, nose, throat and every wound, skin-lesion and or infection site. If hospital admission is necessary, category 1 or 2 patients must be cared for in strict isolation until laboratory results are known. If the patient is proved to be MRSA-positive, the infection control department starts screening every contact – both patients and HCWs. If more than two patients are found, outbreak management for MRSA starts. If MRSA has been diagnosed in HCWs, then they may not carry out any activities in departments in which patients are present. To ‘Destroy’ MRSA, the policy gives guidelines for eradication and treatment, and policies for cleaning and disinfecting. To fulfil this policy at least a 0.5 FTE infection control practitioner is needed.