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Horizontal infection control strategy decreases methicillin-resistant Staphylococcus aureus infection and eliminates
Maria X Traa1, Lorena Barboza, Shira Doron
11Department of Surgery, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA. 2Division of Infectious and Geographic Diseases, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA. 3Department of Medicine and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA.
Objective:
Methicillin-resistant Staphylococcus aureus infection is a significant contributor to morbidity and mortality in hospitalized patients worldwide. Numerous healthcare bodies in Europe and the United States have championed active surveillance per the "search and destroy" model. However, this strategy is associated with significant economic, logistical, and patient costs without any impact on other hospital-acquired pathogens. We evaluated whether horizontal infection control strategies could decrease the prevalence of methicillin-resistant S. aureus infection in the ICU, without the need for active surveillance.
Design And Setting:
Retrospective, observational study in the surgical ICU of a tertiary care medical center in Boston, MA, from 2005 to 2012.
Patients:
A total of 6,697 patients in the surgical ICU.
Interventions:
Evidence-based infection prevention strategies were implemented in an iterative fashion, including 1) hand hygiene program with refresher education campaign, 2) chlorhexidine oral hygiene program, 3) chlorhexidine bathing, 4) catheter-associated bloodstream infection program, and 5) daily goals sheets.
Measurements And Main Results:
The prevalence of methicillin-resistant S. aureus infection fell from 2.66 to 0.69 per 1,000 patient days from 2005 to 2012, an average decrease of 21% per year. The biggest decline in rate of infection was detected in 2008, which may suggest that the catheter-associated bloodstream infection prevention program was particularly effective. Among 4,478 surgical ICU admissions over the last 5 years, not a single case of methicillin-resistant S. aureus bacteremia was observed.
Conclusions:
Aggressive multifaceted horizontal infection control is an effective strategy for reducing the prevalence of methicillin-resistant S. aureus infection and eliminating methicillin-resistant S. aureus bacteremia in the ICU without the need for active surveillance and decontamination.
Insights
Implementing comprehensive horizontal infection control strategies significantly reduced methicillin-resistant Staphylococcus aureus (MRSA) infections in the ICU. This approach eliminated MRSA bacteremia without requiring active surveillance, proving highly effective.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant global threat in healthcare settings.
- Active surveillance (
- search and destroy
- ) is a common strategy but incurs substantial costs and logistical challenges.
- Its impact on other hospital-acquired pathogens is limited.
Purpose of the Study:
- To assess the effectiveness of horizontal infection control strategies in reducing MRSA prevalence within an ICU.
- To determine if these strategies could eliminate MRSA infections without active surveillance.
Main Methods:
- A retrospective, observational study was conducted in a surgical ICU from 2005 to 2012.
- Infection control interventions included enhanced hand hygiene, chlorhexidine oral care and bathing, catheter-associated bloodstream infection (CABSI) prevention, and daily goals sheets.
- The study involved 6,697 patients.
Main Results:
- MRSA infection prevalence decreased by an average of 21% annually, from 2.66 to 0.69 per 1,000 patient-days.
- A notable decline occurred in 2008, potentially linked to the CABSI prevention program.
- No cases of MRSA bacteremia were observed in the last 5 years of the study (4,478 admissions).
Conclusions:
- Multifaceted, horizontal infection control measures are highly effective in reducing MRSA prevalence in ICUs.
- This strategy successfully eliminated MRSA bacteremia without the need for active surveillance or decontamination protocols.
- Horizontal strategies offer a cost-effective and efficient alternative to active surveillance for MRSA control.
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