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Control at hospital level of infections by methicillin-resistant staphylococci in children
Abstract:
Rapid spread of methicillin-resistant staphylococci (MeRS) in a children's hospital is described. Within 4 months of the first isolation MeRS had been isolated from infections in all clinical units. MeRS were also regularly isolated at the out-patient department. Protective isolation of one of the clinical units had no effect on the infection rate by MeRS. The use of antiseptics (Hexachlorophene and chlorhexidine) and gentamicin nose cream in children and staff members in three out of five clinical units resulted in a significant reduction of the prevalence of nose colonization by MeRS in children. In staff members a non-significant reduction of the prevalence of colonization and a significant reduction of the acquisition of MeRS was found. After a few months the infection rate decreased to zero in the units where the measures were introduced. It remained unchanged in the other units. Phage typing of two sets of strains collected at an interval of 6 months showed that the infections were mainly caused by two endemic strains of MeRS. The majority of the infections caused by MeRS was of minor importance. In 16% of the infections a strain was isolated repeatedly and for more than 1 week. After the introduction of antiseptics a relative increase of infections by Gram-negative bacteria was observed. The significance of this phenomenon is discussed.
Insights
Antiseptic use significantly reduced methicillin-resistant staphylococci (MeRS) nasal colonization in children and staff, decreasing infection rates. This intervention proved effective in controlling MeRS spread within a pediatric hospital setting.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Methicillin-resistant staphylococci (MeRS) rapidly spread throughout a children's hospital, affecting all clinical units and outpatient departments.
- Initial infection control measures, such as protective isolation, were ineffective in curbing MeRS transmission.
Purpose of the Study:
- To evaluate the efficacy of antiseptic interventions in reducing MeRS colonization and infection rates in a pediatric hospital.
- To assess the impact of antiseptics on MeRS acquisition in healthcare staff.
Main Methods:
- Implementation of antiseptics (Hexachlorophene, chlorhexidine) and gentamicin nose cream in three of five clinical units for children and staff.
- Phage typing to identify endemic MeRS strains responsible for infections.
- Monitoring of MeRS infection rates and colonization prevalence before and after intervention.
Main Results:
- Significant reduction in MeRS nasal colonization among children in intervention units.
- Significant reduction in MeRS acquisition among staff members in intervention units.
- A decrease in MeRS infection rates to zero in intervention units, while rates remained unchanged in control units.
Conclusions:
- Antiseptic interventions, including topical agents, are effective in controlling MeRS nasal colonization and reducing infection rates in pediatric healthcare settings.
- While MeRS infections were often minor, sustained control was achieved through targeted antiseptic use.
- A potential increase in Gram-negative bacterial infections was observed post-intervention, warranting further investigation.