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A control programme for MRSA (methicillin-resistant Staphylococcus aureus) containment in a paediatric intensive care
M Cosseron-Zerbib1, A M Roque Afonso, T Naas
1Service de Bactériologie-Virologie-Hygiène, Hôpital de Bicêtre, Université Paris Sud, Clamart Cedex, France.
Abstract:
Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly reported as a hospital-acquired pathogen in intensive care units (ICUs). The inconsistent application of hygiene measures by healthcare workers accounts largely for the epidemic dissemination of such resistant strains. The efficacy of a control programme to prevent spread of MRSA was assessed in our paediatric ICU (PICU) from April 1992 to December 1995. Patients initially had weekly MRSA cultures taken from samples of anterior nares and perineum, but from January 1994, cultures were also obtained upon admission. Immediately after notification, all MRSA carriers were isolated. Education of hospital staff was an essential component of our programme. Nosocomial infection rates were recorded retrospectively in 1992 and 1993, and prospectively in 1994 and 1995. Incidence rates between 'pre-programme' and 'programme' periods were compared. The rate of MRSA infection decreased from 5.9-0.8/1000 Patient-Days (PD), (P < 10(-7). MRSA carriage also decreased from 34-2% (P < 10(-9) and the ratio of MRSA to all S. aureus fell from 71-11% (P < 10(-4). The decrease in the global incidence of infection from 20.1-13.9/1000 PD (P = 0.002) was due only to the decrease in MRSA infection. However, between 1994 and 1995, there was a significant increase in the number of transplant patients despite a constant patient/nurse ratio. The nosocomial infection rates caused by other micro-organisms decreased among the transplant patients from 64.8-33.2/1000 transplanted PD (P = 0.009) between 1994 and 1995. At the same time, we observed a slight increase of infections in non-transplanted patients, which may have been due to the effect of increased overall workload on those patients who were supposed to have fewer nosocomial risk factors. We conclude that implementation of infection control measures directed towards limiting person-to-person spread was effective in controlling high MRSA infection rates in a PICU, but it is important to allow enough time for staff to carry out hygiene practices thoroughly.
Insights
A control program significantly reduced Methicillin-resistant Staphylococcus aureus (MRSA) infections in a pediatric ICU by improving hygiene and isolation. This highlights the effectiveness of infection control measures in preventing the spread of resistant bacteria.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Public Health
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is a growing concern in intensive care units (ICUs).
- Inconsistent hygiene practices among healthcare workers contribute to the spread of MRSA.
- Effective control strategies are crucial for managing hospital-acquired infections.
Purpose of the Study:
- To assess the efficacy of an infection control program in reducing MRSA spread in a pediatric ICU (PICU).
- To evaluate the impact of enhanced hygiene measures and staff education on MRSA incidence.
- To compare MRSA infection and carriage rates before and after program implementation.
Main Methods:
- Implemented a control program including enhanced MRSA surveillance (cultures on admission and weekly).
- Instituted isolation protocols for identified MRSA carriers.
- Conducted staff education on hygiene measures.
- Retrospectively and prospectively recorded nosocomial infection rates.
Main Results:
- MRSA infection rates decreased significantly from 5.9 to 0.8 per 1000 patient-days (P < 10(-7)).
- MRSA carriage rates dropped from 34% to 2% (P < 10(-9)), and the MRSA to S. aureus ratio fell from 71% to 11% (P < 10(-4)).
- Global nosocomial infection rates decreased from 20.1 to 13.9 per 1000 patient-days (P = 0.002), primarily due to reduced MRSA infections.
Conclusions:
- The implemented infection control program effectively reduced MRSA infection rates in the PICU.
- Strict adherence to hygiene practices and timely isolation of carriers are key to controlling MRSA.
- Adequate time allocation for staff to perform hygiene measures thoroughly is essential for program success.