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Successful control of endemic MRSA in a cardiothoracic surgical unit
L M Brady1, M Thomson, M A Palmer
1St. Vincent's Hospital, Darlinghurst, NSW.
Abstract:
After a substantial increase in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the Cardiothoracic Surgical Unit at St. Vincent's Hospital, Sydney, a prospective study was undertaken in early 1986 to ascertain the carrier status of all patients entering the Unit. Of 84 patients, 27.4% were found to carry MRSA and the perineum was the major site of carriage, with 69.6% of MRSA positive cases carrying the organism in this site. As a result of these findings, the period of perioperative antibiotic cover was shortened, whole-body washing of patients with a 1% triclosan preparation was instituted and routine postoperative perineal swabs were taken. During the 18 months after implementation of these policies, a highly significant reduction in the number of MRSA carriers and infections was observed. The monitoring of perineal colonization proved to be a useful marker for increases in MRSA in the Unit.
Insights
A study found that 27.4% of patients carried methicillin-resistant Staphylococcus aureus (MRSA), primarily on the perineum. New policies significantly reduced MRSA carriers and infections, highlighting perineal swabs as a key monitoring tool.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Surgical Site Infections
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) prevalence increased in a Cardiothoracic Surgical Unit.
- Patient carrier status for MRSA was a concern.
- A need to identify and control MRSA transmission was identified.
Purpose of the Study:
- To determine the prevalence of MRSA carriage in patients admitted to the Cardiothoracic Surgical Unit.
- To identify the primary site of MRSA carriage.
- To evaluate the impact of new interventions on MRSA rates.
Main Methods:
- Prospective study of 84 patients admitted to the Unit.
- Screening for MRSA carriage, with a focus on perineal sites.
- Implementation of interventions: shortened antibiotic cover, whole-body washing with triclosan, and routine perineal swabs.
Main Results:
- 27.4% of patients were MRSA carriers.
- The perineum was the major site of carriage (69.6% of positive cases).
- Significant reduction in MRSA carriers and infections observed post-intervention.
Conclusions:
- The perineum is a significant site for MRSA carriage in surgical patients.
- Interventions including perineal hygiene and targeted antibiotic policies effectively reduced MRSA.
- Monitoring perineal colonization is a valuable marker for MRSA surveillance in hospital units.