Screening test recommendations for methicillin-resistant Staphylococcus aureus surveillance practices: A cost-minimization analysis

Effectiveness of methicillin-resistant Staphylococcus aureus surveillance among exposed roommates in community hospitals: Conventional culture versus direct PCR

BACKGROUND

Roommates of unrecognized nosocomial methicillin-resistant Staphylococcus aureus (MRSA) cases are at a higher acquisition risk; however, optimal surveillance strategies are unknown.

METHODS

Using simulation, we analyzed surveillance testing and isolation strategies for MRSA among exposed hospital roommates. We compared isolating exposed roommates until conventional culture testing on day 6 and a nasal polymerase chain reaction test on day 3 (PCR3) with/without day 0 culture testing (Cult0). The model represents MRSA transmission in medium-sized hospitals using data and recommends best practices from the literature and Ontario community hospitals.

RESULTS

Cult0 + PCR3 incurred a slightly lower number of MRSA colonizations and 38.9% lower annual cost in the base case compared to Cult0 + culture testing on day 6 because the reduced isolation cost compensated for the increased testing cost. The reduction in MRSA colonizations was due to a 54.5% drop in MRSA transmissions during isolation as PCR3 reduced the exposure of MRSA-free roommates to new MRSA carriers. Removing the day 0 culture test from Cult0 + PCR3 increased total cost, the number of MRSA colonization, and missed cases by $1,631, 4.3%, and 50.9%, respectively. Improvements were higher under aggressive MRSA transmission scenarios.

DISCUSSION AND CONCLUSIONS

Adopting direct nasal polymerase chain reaction testing for determining post-exposure MRSA status reduces transmission risk and costs. Day 0 culture would still be beneficial.

Screening for Methicillin-resistant Staphylococcus aureus Carriage on the Hands of Healthcare Workers: An Assessment for Hand Hygiene Practices

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is capable of causing a wide range of infections. Colonized healthcare workers (HCWs) and contaminated hand-touch surfaces act as a potential source of MRSA in hospitals. This study was conducted to detect the carriage of MRSA in the hands of HCWs during patient care to check awareness among HCWs to follow proper hand hygiene protocol.

Materials and methods

This study was a cross-sectional point prevalence study done in wards and intensive care units (ICUs) of a tertiary care hospital. Hand cultures were collected from HCWs after the clinical rounds, without prior information about the procedure. It was done on three consecutive days to include maximum HCWs from the hospital. Cultures were taken before and after the use of alcohol-based hand rub. Hand cultures were obtained by asking HCWs to touch the surface of chromogenic screening agar for MRSA with their fingertips and thumbs of both the hands.

Results

Of a total of 62 HCWs screened, 32 (51.61%) were positive for MRSA. Among these, seven were doctors. After using alcohol-based hand rub, six HCWs were still positive for MRSA. Another important finding on this screening agar was detection of Candida on the hands of HCWs.

Conclusion

Regular monitoring of hand hygiene compliance is vital to prevent the spread of nosocomial infections. The MRSA screening agar is rapid, simple, cost-effective, and useful to identify the carriage of not only MRSA but also Candida (in the wake of nosocomial outbreaks with Candida auris) in the hands of HCWs. Further studies are required to evaluate the transmission rate of MRSA from HCWs to patients in Indian hospitals.

How to cite this article

Sharma A, Kalita JM, Nag VL. Screening for Methicillin-resistant Staphylococcus aureus Carriage on the Hands of Healthcare Workers: An Assessment for Hand Hygiene Practices. Indian J Crit Care Med 2019;23(12):590–592.