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Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching
Abstract:
During an eight-month period, 25 hospitalized patients became infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) in a 464-bed acute care, medical-surgical teaching hospital. There were only five cases during the eight months prior to the outbreak period (P less than 0.0001). Initial measures, including category-specific isolation and education, did not limit the spread of the outbreak of a strain of MRSA. This prompted institution of additional measures including (1) strict isolation of all infected and colonized cases; (2) prospective microbiological surveillance to detect additional cases; (3) multiple site cultures of identified cases to determine the extent of colonization; (4) employee and environment surveillance; (5) antibiotic decolonization of patients and employees; and (6) educational efforts. The highest number of personnel carriers were noted in one of the critical care units where most of the cases occurred. The decolonization protocol was 100% effective for personnel carriers. The incidence of nosocomial cases of MRSA fell to zero in the five months following the implementation of the strategy. The cost of the entire eradication process was approximately half that of treating a single MRSA bacteremia.
Insights
An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) was controlled by implementing strict isolation, surveillance, and decolonization protocols. This comprehensive strategy effectively eliminated new MRSA cases in the hospital within five months.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- An eight-month period saw a significant increase in methicillin-resistant Staphylococcus aureus (MRSA) hospital-acquired infections and colonizations.
- Initial control measures, including isolation and education, were insufficient to curb the MRSA outbreak.
Purpose of the Study:
- To investigate an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a medical-surgical teaching hospital.
- To evaluate the effectiveness of a multi-faceted intervention strategy to control and eradicate MRSA.
Main Methods:
- Implementation of strict isolation for infected/colonized patients.
- Prospective microbiological surveillance for case detection and multi-site culturing.
- Employee and environmental surveillance, alongside antibiotic decolonization for patients and staff.
- Targeted educational initiatives.
Main Results:
- The MRSA outbreak involved 25 patients, a significant increase from the previous period (P < 0.0001).
- A comprehensive strategy including strict isolation, surveillance, and decolonization led to zero new MRSA cases in the subsequent five months.
- The decolonization protocol was 100% effective in eliminating MRSA carriage among healthcare personnel.
- The total cost of eradication was approximately 50% of treating a single MRSA bacteremia case.
Conclusions:
- A rigorous, multi-component intervention strategy is highly effective in controlling and eradicating MRSA outbreaks in acute care settings.
- Antibiotic decolonization of personnel carriers is a critical component of successful MRSA outbreak management.
- The cost-effectiveness of MRSA eradication strategies can significantly outweigh treatment costs.