Related Experiment Videos
Methicillin-resistant Staphylococcus aureus outbreak: a consensus panel's definition and management guidelines
R P Wenzel1, D R Reagan, J S Bertino
1Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0663, USA.
Objective:
To provide medical personnel with a definition of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) and guidelines for managing potential outbreaks.
Participants:
Eighteen panel members were chosen from different specialties, types of institutions, and geographic regions. Representatives from the American Society of Consultant Pharmacists, the American Society of Health-Systems Pharmacists, the Society for Healthcare Epidemiology of America, and the National Association of Directors of Nursing Administration participated.
Consensus Process:
In preparation for the conference, panel members reviewed the literature and wrote abstracts outlining their personal opinions on the core issues, which were circulated to all participants. During a weekend conference, the panel summarized the reviewed literature, defined an MRSA outbreak, and developed management guidelines.
Evidence:
Published literature, clinical experience, and expert opinion concerning the emergence and subsequent management of MRSA cases in health care institutions.
Results:
An outbreak of MRSA was defined as either an increase in the rate of MRSA cases or a clustering of new cases due to the transmission of a single microbial strain in the health care institution. An increased rate of cases can be defined statistically or experientially and includes both infected and colonized patients. A potential outbreak should trigger stepwise, multidisciplinary actions consisting of basic epidemiologic procedures (phase I) to form an initial epidemiologic hypothesis of an outbreak (phase II) followed by a standard epidemiologic workup (phase III) and microbiologic studies (phase IV) to confirm the hypothesis. Mupirocin calcium treatments should be considered to decolonize health care workers during the fourth phase, even before typing is completed.
Conclusions:
Until studies can be conducted to delineate the effectiveness of different recommendations, the proposed guidelines may provide a useful starting point that can be adapted to meet an individual institution's specific needs.
Insights
A methicillin-resistant Staphylococcus aureus (MRSA) outbreak is defined as increased MRSA cases or transmission of a single strain. Guidelines are provided for managing potential MRSA outbreaks in healthcare settings.
Area of Science:
- Infectious Diseases
- Epidemiology
- Healthcare Management
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings.
- Effective management of MRSA outbreaks requires clear definitions and standardized guidelines.
- Previous approaches to MRSA outbreak management lacked consensus.
Framework:
- Defined an MRSA outbreak as an increased rate of cases or transmission of a single strain.
- Proposed a four-phase approach for managing potential outbreaks: hypothesis generation, epidemiologic workup, and microbiologic studies.
- Recommended considering mupirocin calcium treatment for healthcare worker decolonization.
Implementation:
- Guidelines developed through a consensus process involving 18 panel members from diverse specialties and institutions.
- Literature review, personal opinions, and expert consensus formed the basis for the guidelines.
- The framework involves stepwise, multidisciplinary actions.
Implications:
- Provides a definition and management guidelines for MRSA outbreaks adaptable to institutional needs.
- Aims to improve the response to and control of MRSA in healthcare.
- Serves as a starting point for institutions until further effectiveness studies are available.