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Colet PC, Cruz JP, Cacho G, Al-Qubeilat H, Soriano SS, Cruz CP. Perceived Infection Prevention Climate and Its Predictors Among Nurses in Saudi Arabia. J Nurs Scholarsh 2017; 50:134-142. [PMID: 29193701 DOI: 10.1111/jnu.12360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE This study investigated the staff nurses' perception of the infection prevention climate and its predictors in two hospitals. DESIGN This is a cross-sectional study employing a convenience sample of 224 staff nurses at two general hospitals in Riyadh province. METHODS The study utilized a two-part questionnaire that captures respondents' characteristics and the validated tool on Leading a Culture of Quality for Infection Prevention (LCQ-IP). Both descriptive and inferential statistics were utilized accordingly. RESULTS The prioritization of quality received the highest mean score among the four factors of the scale (mean = 3.89, SD = 0.65), followed by supportive work environment (mean = 3.88, SD = 0.68), psychological safety (mean = 3.85, SD = 0.65), and improvement orientation (mean = 3.84, SD = 0.64). Nationality, clinical experience, and attendance to seminars or training were identified as significant predictors. CONCLUSIONS The respondents perceived the infection prevention climate of the two general hospitals positively. This study strengthens the idea that organizational context influences negatively or positively the programs on infection prevention being implemented in the hospitals. CLINICAL RELEVANCE The result may facilitate nursing and hospital management to reflect, examine, and review their organizational climate, the impact of infection prevention initiatives and patient safety strategies, and the reason to amend related policies or improve procedures, including the promotion of a healthy work environment.
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Affiliation(s)
- Paolo C Colet
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia; Assistant Professor, Nazarbayev University, School of Medicine, Astana, Kazakhstan
| | - Jonas Preposi Cruz
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia, Visiting Professor, Graduate School, Union Christian College, La Union, Philippines
| | - Gabby Cacho
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia
| | - Hikmet Al-Qubeilat
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia
| | - Shiela S Soriano
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia
| | - Charlie P Cruz
- Assistant Lecturer, Laboratory Science Program, University of Wyoming, Casper, WY, USA; and Adjunct Professor, Graduate School, Lyceum of the Philippines University, Batangas, Philippines
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Epidemiology of Staphylococcus aureus in Italy: First nationwide survey, 2012. J Glob Antimicrob Resist 2015; 3:247-254. [PMID: 27842868 DOI: 10.1016/j.jgar.2015.06.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/09/2015] [Accepted: 06/24/2015] [Indexed: 12/17/2022] Open
Abstract
A 3-month epidemiological study to determine the prevalence and antibiotic resistance of Staphylococcus aureus nosocomial infections was performed in 52 centres throughout Italy in 2012. A total of 21,873 pathogens were analysed. The prevalence of S. aureus among all nosocomial pathogens isolated in that period was 11.6% (n=2541), whilst the prevalence of methicillin-resistant S. aureus (MRSA) among the S. aureus was 35.8% (n=910). All tested antimicrobials demonstrated ≥92.2% susceptibility against methicillin-susceptible S. aureus, with the exception of clindamycin (89.7%) and erythromycin (84.2%). Among MRSA, percentages of resistance ranged from 12.6% to >39% for tetracycline, rifampicin, clindamycin and gentamicin; higher percentages were found for erythromycin (65.4%) and fluoroquinolones (72.3-85.8%). Overall, the glycopeptide minimum inhibitory concentration (MIC) distribution showed that 58.3% of strains possessed MICs of 1-2mg/L and few strains were linezolid- or daptomycin-resistant. Molecular characterisation was performed on 102 MRSA selected from Northern, Central and Southern regions. Five major clones were found: Italian/ST228-I (t001-t023-t041-t1686-t3217), 33.3%; USA500/ST8-IV (t008), 17.6%; E-MRSA15/ST22-IVh (t020-t025-t032-t223), 16.7%; USA100/ST5-II (t002-t653-t1349-t2164-t3217-t388), 14.7%; and Brazilian/ST239/241-III (t030-t037), 3.9%. Five PVL-positive CA-MRSA isolates, belonging to USA300 and minor clones, were also identified. In conclusion, this first nationwide surveillance study showed that in Italy, S. aureus infections accounted for 11.6% of all nosocomial infections; MRSA accounted for approximately one-third of the S. aureus isolates and these were multidrug-resistant organisms. Five major MRSA epidemic clones were observed and were inter-regionally distributed, with ST228-SCCmecI becoming predominant.
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Thompson DS, Workman R. Hospital-wide infection control practice and Meticillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU): an observational study. JRSM Open 2014; 5:2054270414547145. [PMID: 25383196 PMCID: PMC4221953 DOI: 10.1177/2054270414547145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives To estimate trends in infection/colonisation with meticillin-resistant Staphylococcus aureus (MRSA) in an intensive care unit (ICU). Design Observational study of results of ICU admission and weekly screens for MRSA. Setting and Participants All ICU admissions in 2001–2012. Interventions ICU admissions were screened for MRSA throughout. In late 2006, screening was extended to the whole hospital and extra measures taken in ICU. Main outcome measures Prevalence of MRSA in ICU admissions and number acquiring MRSA therein. Results In all, 366 of 6565 admissions to ICU were MRSA positive, including 270 of 4466 coming from within the hospital in which prevalence increased with time prior to transfer to ICU. Prevalence in this group was 9.4% (8.2–10.6) in 2001–2006, decreasing to 3.4% (2.3–4.5) in 2007–2009 and 1.3% (0.6–2.0) in 2010–2012, p < 0.001, due to decreased prevalence in those spending >5 days on wards before ICU admission: 18.9% (15.6–22.2) in 2001–2006, 7.1% (4.0–10.2) in 2007–2009 and 1.6% (0.1–3.1) in 2010–2012, p < 0.001. In addition, 201 patients acquired MRSA within ICU, the relative risk being greater when known positives present: 4.34 (3.98–4.70), p < 0.001. Acquisition rate/1000 bed days decreased from 13.3 (11.2–15.4) in 2001–2006 to 3.6 (2.6–4.6) in 2007–2012, p < 0.0001. Of 41 ICU-acquired MRSA bacteraemias, 38 were in 2001–2006. The risk of bacteraemia in those acquiring MRSA decreased from 25% (18.1–31.9) in 2001–2006 to 6.1% (0–12.8) thereafter, p = 0.022. Conclusions Following better hospital-wide infection control, fewer MRSA-positive patients were admitted to ICU with a parallel decrease in acquisition therein. Better practice there reduced the risk of bacteraemia.
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Affiliation(s)
- David S Thompson
- Departments of Medicine and Microbiology, Medway Maritime Hospital, Gillingham, ME7 5NY, UK
| | - Rella Workman
- Departments of Medicine and Microbiology, Medway Maritime Hospital, Gillingham, ME7 5NY, UK
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Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, Mielke M, Peters G, Skov RL, Struelens MJ, Tacconelli E, Witte W, Friedrich AW. Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus. ACTA ACUST UNITED AC 2014; 19. [PMID: 25080142 DOI: 10.2807/1560-7917.es2014.19.29.20860] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe. Many examples have demonstrated that the spread of MRSA within healthcare settings can be reduced by targeted infection control measures. The aim of this systematic literature analysis and review was to summarise the evidence for the use of bacterial cultures for active surveillance the benefit of rapid screening tests, as well as the use of decolonisation therapies and different types of isolation measures. We included 83 studies published between 2000 and 2012. Although the studies reported good evidence supporting the role of active surveillance followed by decolonisation therapy, the effectiveness of single-room isolation was mostly shown in non-controlled studies, which should inspire further research regarding this issue. Overall, this review highlighted that when planning the implementation of preventive interventions, there is a need to consider the prevalence of MRSA, the incidence of infections, the competing effect of standard control measures (e.g. hand hygiene) and the likelihood of transmission in the respective settings of implementation.
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Affiliation(s)
- R Kock
- Institute of Hygiene, University Hospital Munster, Munster, Germany
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Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014. [DOI: 10.1007/s00103-014-1980-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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The prevalence and significance of methicillin-resistant Staphylococcus aureus colonization at admission in the general ICU Setting: a meta-analysis of published studies. Crit Care Med 2014; 42:433-44. [PMID: 24145849 DOI: 10.1097/ccm.0b013e3182a66bb8] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate the prevalence and significance of nasal methicillin-resistant Staphylococcus aureus colonization in the ICU and its predictive value for development of methicillin-resistant S. aureus infection. DATA SOURCES MEDLINE and EMBASE and reference lists of all eligible articles. STUDY SELECTION Studies providing raw data on nasal methicillin-resistant S. aureus colonization at ICU admission, published up to February 2013. Analyses were restricted in the general ICU setting. Medical, surgical, and interdisciplinary ICUs were eligible. ICU studies referring solely on highly specialized ICUs populations and reports on methicillin-resistant S. aureus outbreaks were excluded. DATA EXTRACTION Two authors independently assessed study eligibility and extrapolated data in a blinded fashion. The two outcomes of interest were the prevalence estimate of methicillin-resistant S. aureus nasal colonization at admission in the ICU and the sensitivity/specificity of colonization in predicting methicillin-resistant S. aureus-associated infections. DATA SYNTHESIS Meta-analysis, using a random-effect model, and meta-regression were performed. Pooled data extracted from 63,740 evaluable ICU patients provided an estimated prevalence of methicillin-resistant S. aureus nasal colonization at admission of 7.0% (95% CI, 5.8-8.3). Prevalence was higher for North American studies (8.9%; 95% CI, 7.1-10.7) and for patients screened using polymerase chain reaction (14.0%; 95% CI, 9.6-19). A significant per year increase in methicillin-resistant S. aureus colonization was also noted. In 17,738 evaluable patients, methicillin-resistant S. aureus infections (4.1%; 95% CI, 2.0-6.8) developed in 589 patients. The relative risk for colonized patients was 8.33 (95% CI, 3.61-19.20). Methicillin-resistant S. aureus nasal carriage had a high specificity (0.96; 95% CI, 0.90-0.98) but low sensitivity (0.32; 95% CI, 0.20-0.48) to predict methicillin-resistant S. aureus-associated infections, with corresponding positive and negative predictive values at 0.25 (95% CI, 0.11-0.39) and 0.97 (95% CI, 0.83-1.00), respectively. CONCLUSIONS Among ICU patients, 5.8-8.3% of patients are colonized by methicillin-resistant S. aureus at admission, with a significant upward trend. Methicillin-resistant S. aureus colonization is associated with a more than eight-fold increase in the risk of associated infections during ICU stay, and methicillin-resistant S. aureus infection develops in one fourth of patients who are colonized with methicillin-resistant S. aureus at admission to the ICU.
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Glick SB, Samson DJ, Huang ES, Vats V, Aronson N, Weber SG. Screening for methicillin-resistant Staphylococcus aureus: a comparative effectiveness review. Am J Infect Control 2014; 42:148-55. [PMID: 24360519 DOI: 10.1016/j.ajic.2013.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/25/2013] [Accepted: 07/26/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of health care-associated infections. Although the evidence in support of MRSA screening has been promising, a number of questions remain about the effectiveness of active surveillance. METHODS We searched the literature for studies that examined MRSA acquisition, MRSA infection, morbidity, mortality, harms of screening, and resource utilization when screening for MRSA carriage was compared with no screening or with targeted screening. Because of heterogeneity of the data and weaknesses in study design, meta-analysis was not performed. Strength of evidence (SOE) was determined using the system developed by the Grading of Recommendations Assessment, Development and Evaluation Working Group. RESULTS One randomized controlled trial and 47 quasi-experimental studies met our inclusion criteria. We focused on the 14 studies that addressed health care-associated outcomes and that attempted to control for confounding and/or secular trends, because those studies had the potential to support causal inferences. With universal screening for MRSA carriage compared with no screening, 2 large quasi-experimental studies found reductions in health care-associated MRSA infection. The SOE for this finding is low. For each of the other screening strategies evaluated, this review found insufficient evidence to determine the comparative effectiveness of screening. CONCLUSIONS Although there is low SOE that universal screening of hospital patients decreases MRSA infection, there is insufficient evidence to determine the consequences of universal screening or the effectiveness of other screening strategies.
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Organizational culture and its implications for infection prevention and control in healthcare institutions. J Hosp Infect 2014; 86:1-6. [DOI: 10.1016/j.jhin.2013.10.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 10/21/2013] [Indexed: 12/18/2022]
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Staphylococcus aureus résistant à la méticilline en réanimation. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Borg MA, Camilleri L, Waisfisz B. Understanding the epidemiology of MRSA in Europe: do we need to think outside the box? J Hosp Infect 2012; 81:251-6. [PMID: 22695171 DOI: 10.1016/j.jhin.2012.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) infections, using bacteraemia as a marker, shows a striking geographical pattern in Europe. The prevalence of MRSA is low in Northern European countries, increases into central Europe and reaches its highest levels in the Mediterranean region. This has been attributed to varying levels of implementation of infection control and antibiotic stewardship (ICAS) programmes, but reasons for this variation have not been clearly established. AIM To investigate the possible impact of national cultural dimensions on the epidemiology of MRSA in Europe. METHODS Median proportions of MRSA bacteraemia were sourced for countries participating in the EARS-Net surveillance network in 2010, and correlated with the national cultural dimension scores of Hofstede et al. FINDINGS Significant associations were identified between MRSA proportions and the cultural constructs of uncertainty avoidance (UAI), masculinity (MAS) and power distance. Multiple regression models found significant associations for UAI, MAS and short-term orientation (R(2) adjusted = 0.475; P < 0.001). The model was found to be predictive of MRSA trends identified in several European countries between 2006 and 2010. CONCLUSION Implementation of ICAS programmes often requires behavioural change. Cultural dimensions appear to be key factors affecting perceptions and values among healthcare workers, which in turn are critical for compliance and uptake. Customizing ICAS initiatives to reflect the local cultural background may improve their chances of success.
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Affiliation(s)
- M A Borg
- Infection Control Unit, Mater Dei Hospital, Msida, Malta.
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Zhang M, O’Donoghue M, Ito T, Hiramatsu K, Boost M. Prevalence of antiseptic-resistance genes in Staphylococcus aureus and coagulase-negative staphylococci colonising nurses and the general population in Hong Kong. J Hosp Infect 2011; 78:113-7. [DOI: 10.1016/j.jhin.2011.02.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/25/2011] [Indexed: 11/26/2022]
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Edgeworth JD. Has decolonization played a central role in the decline in UK methicillin-resistant Staphylococcus aureus transmission? A focus on evidence from intensive care. J Antimicrob Chemother 2010; 66 Suppl 2:ii41-7. [DOI: 10.1093/jac/dkq325] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thompson D. Hospital infection control and the reduction in intensive care unit-acquired MRSA between 1996 and 2009. J Hosp Infect 2010; 76:271-2. [PMID: 20547430 DOI: 10.1016/j.jhin.2010.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 04/16/2010] [Indexed: 10/19/2022]
Affiliation(s)
- D Thompson
- Medway Maritime Hospital, Gillingham ME7 5NY, UK
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Petrosillo N, Capone A, Di Bella S, Taglietti F. Management of antibiotic resistance in the intensive care unit setting. Expert Rev Anti Infect Ther 2010; 8:289-302. [PMID: 20192683 DOI: 10.1586/eri.10.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Over the past few decades, an alarming increase of infections caused by antibiotic-resistant pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus species, carbapenem-resistant Pseudomonas aeruginosa, extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp., and multidrug-resistant Acinetobacter spp., has been observed, particularly in intensive care units. For clinicians, the rising resistance rate observed in nosocomial pathogens, when coupled with the lack of effective antimicrobials, represents the real challenge in the therapeutic management of critically ill patients. The contribution of clinicians in minimizing the increasing trend of resistance is represented by reduction of the patients' exposure to antibiotics, which reduces the resistance-selecting pressure, and by avoiding unnecessary antibiotic treatments. Recent issues on strategies to minimize resistance development and to appropriately manage critically ill patients with infections caused by multidrug-resistant organisms in the intensive care unit setting are discussed in this article.
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Affiliation(s)
- Nicola Petrosillo
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, Via Portuense, 292-00149 Rome, Italy.
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Maddox TW, Scantlebury CE, Clegg PD, Dawson S, Pinchbeck GL, Williams NJ. A review of the characteristics and treatment of methicillin-resistant Staphylococcus aureus (MRSA) in the horse and a case series of MRSA infection in four horses. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2009.00026.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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