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Al Musawi S, Alkhaleefa Q, Alnassri S, Alamri A, Alnimr A. Predictive Role of Targeted, Active Surveillance Cultures for Detection of Methicillin-Resistant Staphylococcus aureus. Infect Drug Resist 2021; 14:4757-4764. [PMID: 34795491 PMCID: PMC8594744 DOI: 10.2147/idr.s340871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) colonisation is an important source of healthcare-acquired infections. Reliable screening strategies for MRSA colonisation are essential for the timely implementation of infection control measures. AIM This study determined reliable MRSA screening sites to predict colonisation in resource-limited settings and estimated the impact of missed MRSA cases when shifting from multi- to single-site screening. METHODOLOGY A cross-sectional study was conducted in patients with positive MRSA surveillance cultures from the routinely screened sites (nasal, axillary, groin, and throat) from January 2009 to December 2019. RESULTS A total of 1906 screening tests were positive for MRSA cultures (n = 1345 patients). As a single site, the nasal cavity showed the highest MRSA detection, with a sensitivity of 66.8% (95% CI = 64-69) with 277.9 missed isolation days. Screening three or more anatomical sites detected 97-100% of MRSA cases, with 0-24.5 missed isolation days. Screening the axilla and groin separately or in combination showed a good clinical utility index (CUI) of >0.6 to <0.8, while an excellent CUI was obtained upon screening other site samples (>0.8). The combined nasal and throat cultures demonstrated a sensitivity of 93.2 (95% CI = 91-94) with 57.2 missed isolation days. CONCLUSION Multi-site screening is the optimal strategy for minimising MRSA exposure within a healthcare facility. For active MRSA surveillance, a combination of nasal and throat cultures can provide a practical approach in low-resource settings compared to nasal sampling alone.
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Affiliation(s)
- Safiya Al Musawi
- Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
| | - Qassim Alkhaleefa
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Samia Alnassri
- Department of Infection Control, King Fahad Hospital of the University, Dammam, Kingdom of Saudi Arabia
| | - Aisha Alamri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Amani Alnimr
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Lee AS, Huttner BD, Catho G, Harbarth S. Methicillin-Resistant Staphylococcus aureus: An Update on Prevention and Control in Acute Care Settings. Infect Dis Clin North Am 2021; 35:931-952. [PMID: 34752226 DOI: 10.1016/j.idc.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health-care-associated infections. Controversies regarding the effectiveness of various control strategies have contributed to varying approaches to MRSA control. However, new evidence from large-scale studies has emerged, particularly concerning screening and decolonization. Importantly, implementation and outcomes of control measures in practice are not only influenced by scientific evidence, but also economic, administrative, and political factors, as demonstrated by decreasing MRSA rates in a number of countries after concerted and coordinated efforts at a national level. Flexibility to adapt measures based on local epidemiology and resources is essential for successful MRSA control.
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Affiliation(s)
- Andie S Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
| | - Benedikt D Huttner
- Division of Infectious Diseases, University of Geneva Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Gaud Catho
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
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Trevas D, Caliendo AM, Hanson K, Levy J, Ginocchio CC. Diagnostic Tests Can Stem the Threat of Antimicrobial Resistance: Infectious Disease Professionals Can Help. Clin Infect Dis 2021; 72:e893-e900. [PMID: 33206946 DOI: 10.1093/cid/ciaa1527] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Indexed: 01/01/2023] Open
Abstract
Uptake of existing diagnostics to identify infections more accurately could minimize unnecessary antibiotic use and decrease the growing threat of antibiotic resistance. The Infectious Diseases Society of America (IDSA) and the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) agree that, to improve uptake of existing diagnostics, healthcare providers, health systems, and payors all need better clinical and economic outcomes data to support use of diagnostic tests over empiric use of antibiotics, providers need better tools and education about diagnostic tests, and diagnostics developers need federal funding in the absence of a viable diagnostics market. Recommendations from PACCARB and the IDSA are amplified. Incentives for-and challenges to-diagnostics research, development, and uptake are summarized. Advocacy opportunities are given for infectious disease professionals to join the fight against antimicrobial resistance.
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Affiliation(s)
- Dana Trevas
- Shea & Trevas, Inc, Brandywine, Maryland, USA
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kimberly Hanson
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Section of Clinical Microbiology, Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, Utah, USA
| | - Jaclyn Levy
- Infectious Diseases Society of America, Arlington, Virginia, USA
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Eriksson BKG, Thollström UB, Nederby-Öhd J, Örtqvist Å. Epidemiology and control of meticillin-resistant Staphylococcus aureus in Stockholm County, Sweden, 2000 to 2016: overview of a "search-and-contain" strategy. Eur J Clin Microbiol Infect Dis 2019; 38:2221-2228. [PMID: 31377954 DOI: 10.1007/s10096-019-03664-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/25/2019] [Indexed: 11/30/2022]
Abstract
To review the epidemiology and measures to control meticillin-resistant Staphylococcus aureus, MRSA, in Stockholm between 2000 and 2016 from the perspective of the Department of Communicable Disease Control and Prevention, Stockholm County Council, Sweden. Age, sex, and place of acquisition of their MRSA on all patients reported to the department were reviewed. Measures for control included surveillance through mandatory reporting of cases, screening patients with risk factors for MRSA, strict adherence to basic nursing hygienic principles, isolation of MRSA positive patients in single rooms in dedicated MRSA wards, and cohorting of staff. An MRSA team was created at the Department of Infectious Diseases, Karolinska University Hospital, for follow-up of all cases. Several administrative meetings and cooperative groups were formed that are still in function. From 2000 to 2016, there were 7373 MRSA cases reported. Healthcare-associated MRSA, HA-MRSA, was successfully controlled, and from 2006 onwards, very limited HA-MRSA transmission or outbreaks occurred. However, incidence increased overall, from 9.5 per 100,000 in 2000 to 37.3 per 100,000 in 2016, due to increase of MRSA acquired abroad and of MRSA acquired in the Swedish community. Surveillance and control measures have been successful in containing HA-MRSA in Stockholm, Sweden, but incidence has increased substantially due to imported cases and spread in the Swedish community. The strategy may be termed "search-and-contain" since screening, infection control, follow-up, and advice on personal hygiene were cornerstones of control, whereas eradication of carriage was not.
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Affiliation(s)
- Björn K G Eriksson
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden.
| | - Ulla-Britt Thollström
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Joanna Nederby-Öhd
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Åke Örtqvist
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
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Richards V, Tremblay E. Assessment of current methicillin-resistant Staphylococcus aureus screening protocols and outcomes at an academic medical center. Am J Infect Control 2019; 47:906-910. [PMID: 30885410 DOI: 10.1016/j.ajic.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for many hospital-associated infections. Both MRSA-colonized and MRSA-infected patients must be isolated on contact precautions per the Centers for Disease Control and Prevention guidelines. This study evaluates the current practice for removing MRSA-colonized patients from contact precautions and proposes a new protocol to decrease inconsistencies with screening methodologies. METHODS This was a retrospective chart review of MRSA screening swabs collected at an academic medical center between January 1, 2010 and December 31, 2017. Of those patients with MRSA screening swabs, extra-nasal cultures were also evaluated for MRSA infection. Screening swabs were analyzed for appropriateness of order and timing between swabs and active infections. Analysis of variance and the χ² tests were used to determine significance between groups. RESULTS This study included 8,310 patients with a combined total of 11,601 nasal swabs. Significantly more (P = .0159) patients with 2 negative nasal swabs returned with a recurrent MRSA infection or colonization than those who had 3 consecutive negative nasal swabs (27.8% vs 17.0%, respectively). Additionally, 47.8% of patients only had 1 appropriately ordered negative nasal swab, indicating that a nurse-driven protocol may be more effective in obtaining the full series of samples required to remove contact precautions. CONCLUSIONS The current practice for removing a patient from contact precautions for MRSA is insufficient. The number of negative nasal swabs required should be increased from 2 to 3 and a decolonization protocol should be implemented.
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Affiliation(s)
- Veronica Richards
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL; Department of Infection Prevention and Control, University of Florida Health Shands Hospital, Gainesville, FL.
| | - Elizabeth Tremblay
- Department of Infection Prevention and Control, University of Florida Health Shands Hospital, Gainesville, FL
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Shenoy ES, Lee H, Ryan E, Hou T, Walensky RP, Ware W, Hooper DC. A Discrete Event Simulation Model of Patient Flow in a General Hospital Incorporating Infection Control Policy for Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE). Med Decis Making 2018; 38:246-261. [PMID: 28662601 PMCID: PMC5711633 DOI: 10.1177/0272989x17713474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hospitalized patients are assigned to available staffed beds based on patient acuity and services required. In hospitals with double-occupancy rooms, patients must be additionally matched by gender. Patients with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) must be bedded in single-occupancy rooms or cohorted with other patients with similar MRSA/VRE flags. METHODS We developed a discrete event simulation (DES) model of patient flow through an acute care hospital. Patients are matched to beds based on acuity, service, gender, and known MRSA/VRE colonization. Outcomes included time to bed arrival, length of stay, patient-bed acuity mismatches, occupancy, idle beds, acuity-related transfers, rooms with discordant MRSA/VRE colonization, and transmission due to discordant colonization. RESULTS Observed outcomes were well-approximated by model-generated outcomes for time-to-bed arrival (6.7 v. 6.2 to 6.5 h) and length of stay (3.3 v. 2.9 to 3.0 days), with overlapping 90% coverage intervals. Patient-bed acuity mismatches, where patient acuity exceeded bed acuity and where patient acuity was lower than bed acuity, ranged from 0.6 to 0.9 and 8.6 to 11.1 mismatches per h, respectively. Values for observed occupancy, total idle beds, and acuity-related transfers compared favorably to model-predicted values (91% v. 86% to 87% occupancy, 15.1 v. 14.3 to 15.7 total idle beds, and 27.2 v. 22.6 to 23.7 transfers). Rooms with discordant colonization status and transmission due to discordance were modeled without an observed value for comparison. One-way and multi-way sensitivity analyses were performed for idle beds and rooms with discordant colonization. CONCLUSIONS We developed and validated a DES model of patient flow incorporating MRSA/VRE flags. The model allowed for quantification of the substantial impact of MRSA/VRE flags on hospital efficiency and potentially avoidable nosocomial transmission.
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Affiliation(s)
- Erica S. Shenoy
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics Center, Boston, MA, USA
| | - Erin Ryan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Taige Hou
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Rochelle P. Walensky
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Winston Ware
- Clinical Care Management Unit, Massachusetts General Hospital, Boston, MA, USA
| | - David C. Hooper
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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8
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Werner C, Shaban RZ. Successfully clearing discharged patients of methicillin-resistant Staphylococcus aureus: Opportunities for the prevention and containment of antimicrobial resistance. Infect Dis Health 2017; 23:57-62. [PMID: 30479306 DOI: 10.1016/j.idh.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/29/2017] [Accepted: 10/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Australian hospitals routinely screen for multi-resistant organisms (MRO) to prevent the spread of healthcare-associated infection. The results of positive MRSA screening typically include: informing patient of their MRSA, single accommodation and contact precautions within the health care facility. These actions are associated with both negative and positive psychosocial effects, but also bring economic and human resource costs. MRSA clearance, however, is a less routine practice, and it is typically conducted only while patients are admitted. This paper reports the results of a study implementing a MRSA clearance program that included giving patients the opportunity to continue the clearance swabbing regime once discharged from hospital. METHODS Retrospective cohort study of MRSA clearance between 2013 and 2016 at a private hospital in Australia. RESULTS The MRSA clearance program was successful in increasing the MRSA clearance rate from 0 patients in 2013 to 13% (n12) in 2014, 11% (n10) in 2015, and 18% (n14) in 2016. CONCLUSION Allowing patients to continuing participation in MRSA clearance following discharge has increased the clearance rate of MRSA. Clearing patients of MRSAs is advantageous to patients, the health system and society, reducing health economic costs and the negative psychosocial effects associated with contact precautions.
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Affiliation(s)
- Curt Werner
- Pindara Private Hospital, Allchurch Avenue, Benowa 4212, Gold Coast, QLD, Australia.
| | - Ramon Z Shaban
- Infection Control Department, Division of Infectious Diseases and Immunology, Gold Coast Hospital and Health Service & Griffith University, Level 2, Block E Gold Coast University Hospital, Southport, QLD 4215, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydeny and Western Sydney Local Health District, Westmead, NSW 2145, Australia
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9
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Frickmann H, Hahn A, Schwarz NG, Hagen RM, Dekker D, Hinz R, Micheel V, Hogan B, May J, Rakotozandrindrainy R. Influence of Broth Enrichment as well as Storage and Transport Time on the Sensitivity of MRSA Surveillance in the Tropics. Eur J Microbiol Immunol (Bp) 2017; 7:274-277. [PMID: 29403655 PMCID: PMC5793696 DOI: 10.1556/1886.2017.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 11/19/2022] Open
Abstract
Direct growth on blood and screening agar for methicillin-resistant Staphylococcus aureus (MRSA) at a tropical surveillance site was compared with broth enrichment and subsequent growth on selective MRSA agar after international sample transport. In Madagascar, 1548 swabs from an MRSA surveillance study were assessed for growth on Columbia blood agar enriched with 5% sheep blood and MRSA screening agar at the surveillance site with subsequent cold storage of the samples and shipment to Germany. In Germany, 1541 shipped samples were analyzed by non-selective broth enrichment with subsequent culture on MRSA selective agar. A total of 28 MRSA isolates were detected. Of these, 20 strains were isolated from direct culture on blood and MRSA screening agars at the surveillance site, 24 MRSA strains were isolated using the broth enrichment method in Germany, and 16 MRSA strains were identified by both approaches. In spite of the observed die-off of individual strains due to long-term storage and transport, broth enrichment with subsequent screening on MRSA selective agar after international sample shipment led to comparable sensitivity of MRSA detection like streaking on blood and MRSA agar at the tropical surveillance site.
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Affiliation(s)
- Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Andreas Hahn
- Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Norbert Georg Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Ralf Matthias Hagen
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Department of Preventive Medicine, Bundeswehr Medical Academy, Munich, Germany
| | - Denise Dekker
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Rebecca Hinz
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Micheel
- Central Institute of the Bundeswehr Medical Service Koblenz, Koblenz, Germany
| | - Benedikt Hogan
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Jürgen May
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
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Lee AS, Huttner B, Harbarth S. Prevention and Control of Methicillin-Resistant Staphylococcus aureus in Acute Care Settings. Infect Dis Clin North Am 2017; 30:931-952. [PMID: 27816144 DOI: 10.1016/j.idc.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health care-associated infections worldwide. Controversies with regard to the effectiveness of various MRSA control strategies have contributed to varying approaches to the control of this pathogen in different settings. However, new evidence from large-scale studies has emerged, particularly with regards to MRSA screening and decolonization strategies, which will inform future control practices. The implementation as well as outcomes of control measures in the real world is not only influenced by scientific evidence but also depends on economic, administrative, governmental, and political influences.
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Affiliation(s)
- Andie S Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia.
| | - Benedikt Huttner
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland; Division of Infectious Diseases, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
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Hamill ME, Reed CR, Fogel SL, Bradburn EH, Powers KA, Love KM, Baker CC, Collier BR. Contact Isolation Precautions in Trauma Patients: An Analysis of Infectious Complications. Surg Infect (Larchmt) 2017; 18:273-281. [DOI: 10.1089/sur.2015.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Mark E. Hamill
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Christopher R. Reed
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Sandy L. Fogel
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Eric H. Bradburn
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Kinga A. Powers
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Katie M. Love
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Christopher C. Baker
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
| | - Bryan R. Collier
- Department of Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia
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Spencer M, Uettwiller-Geiger D, Sanguinet J, Johnson HB, Graham D. Infection preventionists and laboratorians: Case studies on successful collaboration. Am J Infect Control 2016; 44:964-8. [PMID: 27079246 DOI: 10.1016/j.ajic.2016.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
Efforts to reduce the incidence of hospital-acquired infection (HAI) remain a significant focus for health care facilities, particularly in this era of drug-resistant organisms. With as many as 1 in every 25 hospitalized patients acquiring an infection, the need to minimize the risk of HAIs is widely recognized as critical. Advances in the fields of biomedical technology, microbiology, pharmacology, and infection control and prevention, among others, have played a tremendous role in these efforts. However, evidence suggests that a key element in this battle against HAIs is missing: collaboration and communication between these groups in health care facilities-particularly in microbiology and infection prevention. The need for collaboration between infection preventionists (IPs) and laboratorians has been addressed in the literature; however, a survey conducted by the APIC and the American Society for Microbiology demonstrated that both IPs and laboratorians feel they lack the tools to engage in this collaboration. This article addresses strategies for a working partnership between IPs and laboratorians and reports 3 case studies on successful collaborations at major medical centers.
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13
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Guerrero DM, Wagner M, Carson G, Hanish C, Thompson J, Orr M, Roth F, Carson PJ. Utility of a single nasal polymerase chain reaction assay in predicting absence of skin and environmental contamination in hospitalized patients with past methicillin-resistant Staphylococcus aureus. Am J Infect Control 2016; 44:711-3. [PMID: 26874408 DOI: 10.1016/j.ajic.2015.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/03/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
We evaluated hospitalized patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) for persistent colonization and need for contact precautions. Up to 3 daily cultures of nares, skin, and any present wounds were compared with a single nasal polymerase chain reaction (PCR) assay. Most patients (76.2%) were no longer colonized with MRSA. A single PCR assay was sufficient to exclude persistent colonization and environmental contamination and remove the contact precautions.
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14
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Hospital based clearance of patients with skin and soft tissue methicillin resistant Staphylococcus aureus (MRSA): A systematic review of the literature. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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The Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations. Infect Control Hosp Epidemiol 2016; 37:782-90. [PMID: 27019995 DOI: 10.1017/ice.2016.54] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the impact of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus (MRSA/VRE) designations, or flags, on selected hospital operational outcomes. DESIGN Retrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010-2011. METHODS Operational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Covariates considered included demographic and clinical characteristics: age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination. RESULTS Overall, 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 hours (9.63 hours [95% CI, 9.39-9.88] vs 8.60 hours [95% CI, 8.47-8.73]). These patients had 1.19 times the odds of experiencing an acuity-unrelated within-hospital transfer [95% CI, 1.13-1.26] and a mean length of stay 1.76 days longer (7.03 days [95% CI, 6.82-7.24] vs 5.27 days [95% CI, 5.15-5.38]) than patients with no MRSA/VRE flag. CONCLUSIONS MRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and to improve inpatient flow. Infect Control Hosp Epidemiol 2016;37:782-790.
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Shenoy ES, Lee H, Cotter JA, Ware W, Kelbaugh D, Weil E, Walensky RP, Hooper DC. Impact of rapid screening for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions. Am J Infect Control 2016; 44:215-21. [PMID: 26440593 DOI: 10.1016/j.ajic.2015.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND A history of methicillin-resistant Staphylococcus aureus (MRSA) is a determinant of inpatient bed assignment. METHODS We assessed outcomes associated with rapid testing and discontinuation of MRSA contact precautions (CP) in a prospective cohort study of polymerase chain reaction (PCR)-based screening in the Emergency Department (ED) of Massachusetts General Hospital. Eligible patients had a history of MRSA and were assessed and enrolled if documented off antibiotics with activity against MRSA and screened for nasal colonization (subject visit). PCR-negative subjects had CP discontinued; the primary outcome was CP discontinuation. We identified semiprivate rooms in which a bed was vacant owing to the CP status of the study subject, calculated the hours of vacancy, and compared idle bed-hours by PCR results. Program costs were compared with predicted revenue. RESULTS There were 2864 eligible patients, and 648 (22.6%) subject visits were enrolled. Of these, 65.1% (422/648) were PCR-negative and had CP discontinued. PCR-negative subjects had fewer idle bed-hours compared with PCR-positive subjects (28.6 ± 25.2 vs 75.3 ± 70.5; P < .001). The expected revenues from occupied idle beds and averted CP costs ranged from $214,160 to $268,340, and exceeded the program costs. CONCLUSION A program of targeted PCR-based screening for clearance of MRSA colonization resulted in expected revenues and decreased CP costs that outweighed programmatic costs.
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Affiliation(s)
- Erica S Shenoy
- Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA; Infection Control Unit, Massachusetts General Hospital, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
| | - Hang Lee
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA
| | - Jessica A Cotter
- Infection Control Unit, Massachusetts General Hospital, Boston, MA
| | - Winston Ware
- Clinical Care Management Unit, Massachusetts General Hospital, Boston, MA
| | - Douglas Kelbaugh
- Partners Information Systems, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, MA
| | - Eric Weil
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Massachusetts General Physicians Organization
| | - Rochelle P Walensky
- Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - David C Hooper
- Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA; Infection Control Unit, Massachusetts General Hospital, Boston, MA.
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Overview of Molecular Diagnostics in Multiple-Drug-Resistant Organism Prevention: Focus on Multiple-Drug-Resistant Gram-Negative Bacterial Organisms. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Role of Molecular Methods in Improving Public Health Surveillance of Infections Caused by Antimicrobial-Resistant Bacteria in Health Care and Community Settings. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Increasing the efficiency of a targeted methicillin-resistant Staphylococcus aureus screening program. Am J Infect Control 2016; 44:117-9. [PMID: 26769283 DOI: 10.1016/j.ajic.2015.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 11/23/2022]
Abstract
An interdisciplinary team implemented a screening program targeting patients with a history of methicillin-resistant Staphylococcus aureus (MRSA), to reduce unnecessary contact isolation. After converting from a 2-step culture-based protocol to single polymerase chain reaction (PCR) testing, we increased the efficiency of the screening program from 77% to 100%. Despite the higher cost of PCR-based testing, this program remained cost-saving.
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Hübner C, Hübner NO, Wegner C, Flessa S. Impact of different diagnostic technologies for MRSA admission screening in hospitals - a decision tree analysis. Antimicrob Resist Infect Control 2015; 4:50. [PMID: 26635952 PMCID: PMC4668619 DOI: 10.1186/s13756-015-0093-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/12/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hospital infections with multiresistant bacteria, e.g., Methicillin-resistant Staphylococcus aureus (MRSA), cause heavy financial burden worldwide. Rapid and precise identification of MRSA carriage in combination with targeted hygienic management are proven to be effective but incur relevant extra costs. Therefore, health care providers have to decide which MRSA screening strategy and which diagnostic technology should be applied according to economic criteria. AIM The aim of this study was to determine which MRSA admission screening and infection control management strategy causes the lowest expected cost for a hospital. Focus was set on the Point-of-Care Testing (PoC). METHODS A decision tree analytic cost model was developed, primarily based on data from peer-reviewed literature. In addition, univariate sensitivity analyses of the different input parameters were conducted to study the robustness of the results. FINDINGS In the basic analysis, risk-based PoC screening showed the highest mean cost savings with 14.98 € per admission in comparison to no screening. Rapid universal screening methods became favorable at high MRSA prevalence, while in situations with low MRSA transmission rates omission of screening may be favorable. CONCLUSION Early detection of MRSA by rapid PoC or PCR technologies and consistent implementation of appropriate hygienic measures lead to high economic efficiency of MRSA management. Whether general or targeted screening is more efficient depends mainly on epidemiological and infrastructural parameters.
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Affiliation(s)
- Claudia Hübner
- />Institute of Health Care Management, University of Greifswald, Friedrich-Loeffler-Str. 70, 17489 Greifswald, Germany
| | - Nils-Olaf Hübner
- />Institute of Hygiene and Environmental Health, University Medicine of Greifswald, Greifswald, Germany
- />IMD laboratory network, MVZ Greifswald GmbH, Greifswald, Germany
| | - Christian Wegner
- />Institute of Hygiene and Environmental Health, University Medicine of Greifswald, Greifswald, Germany
| | - Steffen Flessa
- />Institute of Health Care Management, University of Greifswald, Friedrich-Loeffler-Str. 70, 17489 Greifswald, Germany
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21
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Affiliation(s)
- Emily W Gottenborg
- Hospital Medicine Section, Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Leprino Building, 4th Floor, Mailstop F-782, 12401 East 17th Avenue, Aurora, CO 80045, USA
| | - Michelle A Barron
- Division of Infectious Diseases, Department of Medicine, University of Colorado Hospital Infection Prevention and Control, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, B168, Aurora, CO 80045, USA
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22
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Spencer M, Barnes S, Parada J, Brown S, Perri L, Uettwiller-Geiger D, Johnson HB, Graham D. A primer on on-demand polymerase chain reaction technology. Am J Infect Control 2015. [PMID: 26198577 DOI: 10.1016/j.ajic.2015.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Efforts to reduce health care-associated infections (HAIs) have grown in both scale and sophistication over the past few decades; however, the increasing threat of antimicrobial resistance and the impact of new legislation regarding HAIs on health care economics make the fight against them all the more urgent. On-demand polymerase chain reaction (PCR) technology has proven to be a highly effective weapon in this fight, offering the ability to accurately and efficiently identify disease-causing pathogens such that targeted and directed therapy can be initiated at the point of care. As a result, on-demand PCR technology has far-reaching influences on HAI rates, health care outcomes, hospital length of stay, isolation days, patient satisfaction, antibiotic stewardship, and health care economics. The basics of on-demand PCR technology and its potential to impact health care have not been widely incorporated into health care education and enrichment programs for many of those involved in infection control and prevention, however. This article serves as a primer on on-demand PCR technology and its ramifications.
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Affiliation(s)
| | - Sue Barnes
- Kaiser Permanente Infection Prevention, Oakland, CA
| | - Jorge Parada
- Loyola University Medical System Infection Control Program and Loyola University Stritch School of Medicine Department of Infectious Diseases, Chicago, IL; Hines Veterans Affairs Hospital Center for Management of Complex Chronic Care, Hines, IL
| | - Scott Brown
- University of Florida/Shands Hospital Department of Infection Control, Orlando, FL
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Abstract
PURPOSE OF REVIEW To describe the latest evidence for methicillin-resistant Staphylococcus aureus (MRSA) infection control strategies, with particular emphasis on active surveillance cultures with contact precautions and targeted decolonization, and their impact. RECENT FINDINGS Several major trials published last year questioned the effectiveness of universal screening and contact precautions in controlling MRSA. These trials generally recommend universal decolonization as part of bundles to control MRSA, especially in ICUs, with some even concluding that universal decolonization should replace active screening and contact precautions. However, emerging resistance to agents used for decolonization, such as mupirocin and chlorhexidine, is a major concern. Several other studies confirmed a combination of hand hygiene enhancement, screening, contact precaution and targeted decolonization as a more viable MRSA infection control strategy for specific population groups. SUMMARY Universal decolonization is an acceptable MRSA control strategy for intensive care units; however, close monitoring of chlorhexidine and mupirocin resistance is warranted. As a strategy, screening and contact precautions are suitable for hospital-wide MRSA control. Targeted decolonization is a proven measure for patients undergoing clean surgery. Enhancement of hand hygiene is a core measure regardless of the strategy.
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López‐Alcalde J, Mateos‐Mazón M, Guevara M, Conterno LO, Solà I, Cabir Nunes S, Bonfill Cosp X. Gloves, gowns and masks for reducing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in the hospital setting. Cochrane Database Syst Rev 2015; 2015:CD007087. [PMID: 26184396 PMCID: PMC7026606 DOI: 10.1002/14651858.cd007087.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Meticillin-resistant Staphylococcus aureus (MRSA; also known as methicillin-resistant S aureus) is a common hospital-acquired pathogen that increases morbidity, mortality, and healthcare costs. Its control continues to be an unresolved issue in many hospitals worldwide. The evidence base for the effects of the use of gloves, gowns or masks as control measures for MRSA is unclear. OBJECTIVES To assess the effectiveness of wearing gloves, a gown or a mask when contact is anticipated with a hospitalised patient colonised or infected with MRSA, or with the patient's immediate environment. SEARCH METHODS We searched the Specialised Registers of three Cochrane Groups (Wounds Group on 5 June 2015; Effective Practice and Organisation of Care (EPOC) Group on 9 July 2013; and Infectious Diseases Group on 5 January 2009); CENTRAL (The Cochrane Library 2015, Issue 6); DARE, HTA, NHS EED, and the Methodology Register (The Cochrane Library 2015, Issue 6); MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to June week 1 2015); EMBASE (1974 to 4 June 2015); Web of Science (WOS) Core Collection (from inception to 7 June 2015); CINAHL (1982 to 5 June 2015); British Nursing Index (1985 to 6 July 2010); and ProQuest Dissertations & Theses Database (1639 to 11 June 2015). We also searched three trials registers (on 6 June 2015), references list of articles, and conference proceedings. We finally contacted relevant individuals for additional studies. SELECTION CRITERIA Studies assessing the effects on MRSA transmission of the use of gloves, gowns or masks by any person in the hospital setting when contact is anticipated with a hospitalised patient colonised or infected with MRSA, or with the patient's immediate environment. We did not assess adverse effects or economic issues associated with these interventions.We considered any comparator to be eligible. With regard to study design, only randomised controlled trials (clustered or not) and the following non-randomised experimental studies were eligible: quasi-randomised controlled trials (clustered or not), non-randomised controlled trials (clustered or not), controlled before-and-after studies, controlled cohort before-after studies, interrupted time series studies (controlled or not), and repeated measures studies. We did not exclude any study on the basis of language or date of publication. DATA COLLECTION AND ANALYSIS Two review authors independently decided on eligibility of the studies. Had any study having been included, two review authors would have extracted data (at least for outcome data) and assessed the risk of bias independently. We would have followed the standard methodological procedures suggested by Cochrane and the Cochrane EPOC Group for assessing risk of bias and analysing the data. MAIN RESULTS We identified no eligible studies for this review, either completed or ongoing. AUTHORS' CONCLUSIONS We found no studies assessing the effects of wearing gloves, gowns or masks for contact with MRSA hospitalised patients, or with their immediate environment, on the transmission of MRSA to patients, hospital staff, patients' caregivers or visitors. This absence of evidence should not be interpreted as evidence of no effect for these interventions. The effects of gloves, gowns and masks in these circumstances have yet to be determined by rigorous experimental studies, such as cluster-randomised trials involving multiple wards or hospitals, or interrupted time series studies.
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Affiliation(s)
- Jesús López‐Alcalde
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
| | - Marta Mateos‐Mazón
- University Hospital Central de AsturiasDepartment of Preventive MedicineAvenida de Roma s/nOviedoOviedoSpain33006
| | - Marcela Guevara
- Public Health Institute of Navarre, CIBER Epidemiología y Salud Pública (CIBERESP), IdiSNAC/ Leyre 15PamplonaNavarreSpainE‐31003
| | - Lucieni O Conterno
- Marilia Medical SchoolDepartment of General Internal Medicine and Clinical Epidemiology UnitAvenida Monte Carmelo 800FragataMariliaSão PauloBrazil17519‐030
| | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
| | | | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)BarcelonaCatalunyaSpain08041
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25
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Reconsidering Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus. Infect Control Hosp Epidemiol 2015; 36:1163-72. [DOI: 10.1017/ice.2015.156] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUNDWhether contact precautions (CP) are required to control the endemic transmission of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in acute care hospitals is controversial in light of improvements in hand hygiene, MRSA decolonization, environmental cleaning and disinfection, fomite elimination, and chlorhexidine bathing.OBJECTIVETo provide a framework for decision making around use of CP for endemic MRSA and VRE based on a summary of evidence related to use of CP, including impact on patients and patient care processes, and current practices in use of CP for MRSA and VRE in US hospitals.DESIGNA literature review, a survey of Society for Healthcare Epidemiology of America Research Network members on use of CP, and a detailed examination of the experience of a convenience sample of hospitals not using CP for MRSA or VRE.PARTICIPANTSHospital epidemiologists and infection prevention experts.RESULTSNo high quality data support or reject use of CP for endemic MRSA or VRE. Our survey found more than 90% of responding hospitals currently use CP for MRSA and VRE, but approximately 60% are interested in using CP in a different manner. More than 30 US hospitals do not use CP for control of endemic MRSA or VRE.CONCLUSIONSHigher quality research on the benefits and harms of CP in the control of endemic MRSA and VRE is needed. Until more definitive data are available, the use of CP for endemic MRSA or VRE in acute care hospitals should be guided by local needs and resources.Infect Control Hosp Epidemiol 2015;36(10):1163–1172
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26
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Simmons BP, Larson EL. Multiple drug resistant organisms in healthcare: the failure of contact precautions. J Infect Prev 2015; 16:178-181. [PMID: 28989425 PMCID: PMC5074191 DOI: 10.1177/1757177415570104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
| | - Elaine L Larson
- School of Nursing, Mailman School of
Public Health, New York, NY, USA
- Columbia University, New York, NY,
USA
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27
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Patel PA, Robicsek A, Grayes A, Schora DM, Peterson KE, Wright MO, Peterson LR. Evaluation of multiple real-time PCR tests on nasal samples in a large MRSA surveillance program. Am J Clin Pathol 2015; 143:652-8. [PMID: 25873498 DOI: 10.1309/ajcpmdy32ztdxpfc] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES We evaluated the LightCycler MRSA Advanced Test (Roche Molecular Diagnostics, Pleasanton, CA), the BD MAX MRSA assay (Becton Dickinson, Franklin Lakes, NJ), and the Xpert MRSA assay (Cepheid, Sunnyvale, CA) on nasal samples using the same population. METHODS Admission and discharge nasal swabs were collected from inpatients using a double-headed swab. One swab was plated onto CHROMagar MRSA (CMA; Becton Dickinson, Sparks, MD) and then broken off into tryptic soy broth (TSB) for enrichment. TSB was incubated for 24 hours and then plated to CMA. The molecular tests were performed on the second swab. We analyzed the cost benefit of testing to evaluate what parameters affect hospital resources. RESULTS A total of 27,647 specimens were enrolled. The sensitivity/specificity was 98.3%/98.9% for the LightCycler MRSA Advanced Test and 95.7%/98.8% for the Xpert MRSA assay, but the difference was not significant. The positive predictive value was 86.7% for the LightCycler MRSA Advanced Test, 82.7% for the Xpert MRSA assay (P > .1), and 72.2% and for the BD MAX MRSA test (P < .001 compared with the LightCycler MRSA Advanced Test). All three assays were cost-effective, with the LightCycler MRSA Advanced Test having the highest economic return. CONCLUSIONS Our results suggest that the performance of the three commercial assays is similar. When assessing economic cost benefit of methicillin-resistant Staphylococcus aureus screening, the two measures with the most impact are the cost of the test and the specificity of the assay results.
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Affiliation(s)
| | - Ari Robicsek
- NorthShore University HealthSystem, Evanston, IL
- NorthShore University of Chicago Pritzker School of Medicine, Chicago, IL
| | | | | | | | | | - Lance R. Peterson
- NorthShore University HealthSystem, Evanston, IL
- NorthShore University of Chicago Pritzker School of Medicine, Chicago, IL
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28
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Economic analysis of universal active surveillance screening for methicillin-resistant Staphylococcus aureus: perspective matters. Infect Control Hosp Epidemiol 2015; 36:14-6. [PMID: 25627756 DOI: 10.1017/ice.2014.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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"Bringing down the flag": removing the contact precautions label for non-hospitalized patients with prior methicillin-resistant Staphylococcus aureus infection or colonization. Infect Control Hosp Epidemiol 2015; 36:578-80. [PMID: 25626471 DOI: 10.1017/ice.2015.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A policy consensus has not been reached regarding discontinuing contact precautions in patients with a history of methicillin-resistant Staphylococcus aureus (MRSA). We found that as many as 72% of outpatients flagged for past MRSA were no longer carriers, and a single nasal PCR test provided a reasonable negative predictive value for removing contact precautions.
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30
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Lekkerkerk WSN, Uljee M, Prkić A, Maas BDPJ, Severin JA, Vos MC. Follow-up cultures for MRSA after eradication therapy: are three culture-sets enough? J Infect 2015; 70:491-8. [PMID: 25597821 DOI: 10.1016/j.jinf.2015.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/23/2014] [Accepted: 01/04/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We compared the standard procedure of three MRSA follow-up culture sets to six to determine the number of recurrences detected between the third and sixth follow-up culture-set, and studied possible risk factors for MRSA recurrence. METHODS A retrospective carrier cohort (2005-2010) was studied. Data was collected on MRSA culture-sets, follow-up, risk factors and outcome (recurrences during follow-up). We compared outcome between three and six follow-up MRSA culture sets, between HCWs and patients groups for complicated or uncomplicated carriers, and between nose-throat carriers and other carriers. RESULTS Of 406 MRSA carriers, 179 had received eradication therapy and had a negative first follow-up MRSA culture-set. Between the third and sixth follow-up culture-set 54% (35/65) of total recurrences occurred. Over 88% of all recurrences were detected within two months. Combined nose and throat carriage OR 25.5 (1.6-419.1)) and intravascular lines (OR 13.6 (1.2-156.2)) were risk factors for early recurrence. CONCLUSIONS We recommend five culture-sets till one year after successful eradication therapy with a distinction between those at risk for early recurrence and HCWs who require frequent culturing in the beginning and those not at risk for early recurrence. This recommendation is a balance between the need for swift detection of MRSA recurrence and the patients' burden.
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Affiliation(s)
- Wouter S N Lekkerkerk
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
| | - Marissa Uljee
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Ante Prkić
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Britta D P J Maas
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Juliëtte A Severin
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Margreet C Vos
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
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Ruhnke M, Arnold R, Gastmeier P. Infection control issues in patients with haematological malignancies in the era of multidrug-resistant bacteria. Lancet Oncol 2014; 15:e606-e619. [PMID: 25456379 DOI: 10.1016/s1470-2045(14)70344-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Drug-resistant Gram-negative and Gram-positive bacteria are now increasingly identified as a cause of infections in immunocompromised hosts. Bacteria identified include the multidrug-resistant (MDR) and even pandrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, as well as carbapenem-resistant Enterobacteriaceae spp. The threat from MDR pathogens has been well-documented in the past decade with warnings about the consequences of inappropriate use of antimicrobial drugs. Resistant bacteria can substantially complicate the treatment of infections in critically ill patients and can have a substantial effect on mortality. Inappropriate antimicrobial treatment can affect morbidity, mortality, and overall health-care costs. Evidence-based data for prevention and control of MDR pathogen infections in haematology are scarce. Although not yet established a bundle of infection control and prevention measures with an anti-infective stewardship programme is an important strategy in infection control, diagnosis, and antibiotic selection with optimum regimens to ensure a successful outcome for patients.
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Affiliation(s)
- Markus Ruhnke
- Department of Hematology and Oncology, Paracelsus-Hospital Osnabrück, Germany.
| | - Renate Arnold
- Medical Department, Division of Haematology, Oncology and Tumour Immunology, Charité Campus Virchow Klinikum, Institute of Hygiene and Environmental Medicine, University Medicine, Berlin, Germany
| | - Petra Gastmeier
- Medical Department, Division of Haematology, Oncology and Tumour Immunology, Charité Campus Benjamin Franklin, Institute of Hygiene and Environmental Medicine, University Medicine, Berlin, Germany
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Ghosh A, Jiao L, Al-Mutawa F, O'Neill C, Mertz D. Value of an active surveillance policy to document clearance of meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci amongst inpatients with prolonged admissions. J Hosp Infect 2014; 88:230-3. [PMID: 25458743 DOI: 10.1016/j.jhin.2014.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
This article reports the impact of an active surveillance policy to identify clearance of meticillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) in known colonized inpatients with prolonged admissions in order to discontinue isolation precautions. Amongst 365 colonized patients with hospital admissions exceeding 30 days, clearance rates of 11% for MRSA and 18% for VRE were found after a median of 23 days and 26.5 days, respectively, resulting in a saving of 2152 patient-days of contact precautions over one year. This has proven to be a cost-beneficial policy.
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Affiliation(s)
- A Ghosh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - L Jiao
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - F Al-Mutawa
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - C O'Neill
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - D Mertz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada.
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Valencia-Rey PA, Strymish J, Robillard E, Evans M, Weinberg J, Gupta K. Survival time of methicillin-resistant Staphylococcus aureus-free status after institutional clearance. Infect Control Hosp Epidemiol 2014; 35:1271-6. [PMID: 25203181 DOI: 10.1086/678065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the durability of methicillin-resistant Staphylococcus aureus (MRSA)-free status after patients are removed from contact precautions and the association of specific clearance policy variables with survival. DESIGN Retrospective cohort study from October 2007 to April 2013. SETTING Veteran Affairs Boston Healthcare System. PARTICIPANTS Patients with a prior history of MRSA who were removed from contact precautions after deemed cleared of their MRSA status by infection prevention. METHODS Active nasal screening results and clinical data from acute, long-term, and outpatient care facilities were evaluated to determine survival of MRSA-free status in a time-to-event analysis. RESULTS A total of 351 unique patients were followed for 107,112 patient-days. The median age was 68 years. Overall, 249 (71%) of patients remained MRSA-free, and 102 (29%) reverted to MRSA positive. The median MRSA-free survival was 880 days. Comorbidities, presence of indwelling devices, and the use of systemic antibiotics at the time of clearance screening were not associated with MRSA-free survival. More than 21,000 days of inpatient isolation days were avoided during the study period. CONCLUSIONS The majority of patients removed from contact precautions remained MRSA-free for more than 2 years. Antibiotic use at the time of clearance was not associated with reductions in MRSA-free survival. These findings can be used to simplify clearance criteria, promote clearance policies, and reduce patient isolation days.
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Affiliation(s)
- Paula A Valencia-Rey
- Department of Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
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35
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Shenoy ES, Paras ML, Noubary F, Walensky RP, Hooper DC. Natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE): a systematic review. BMC Infect Dis 2014; 14:177. [PMID: 24678646 PMCID: PMC4230428 DOI: 10.1186/1471-2334-14-177] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/19/2014] [Indexed: 11/17/2022] Open
Abstract
Background No published systematic reviews have assessed the natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE). Time to clearance of colonization has important implications for patient care and infection control policy. Methods We performed parallel searches in OVID Medline for studies that reported the time to documented clearance of MRSA and VRE colonization in the absence of treatment, published between January 1990 and July 2012. Results For MRSA, we screened 982 articles, identified 16 eligible studies (13 observational studies and 3 randomized controlled trials), for a total of 1,804 non-duplicated subjects. For VRE, we screened 284 articles, identified 13 eligible studies (12 observational studies and 1 randomized controlled trial), for a total of 1,936 non-duplicated subjects. Studies reported varying definitions of clearance of colonization; no study reported time of initial colonization. Studies varied in the frequency of sampling, assays used for sampling, and follow-up period. The median duration of total follow-up was 38 weeks for MRSA and 25 weeks for VRE. Based on pooled analyses, the model-estimated median time to clearance was 88 weeks after documented colonization for MRSA-colonized patients and 26 weeks for VRE-colonized patients. In a secondary analysis, clearance rates for MRSA and VRE were compared by restricting the duration of follow-up for the MRSA studies to the maximum observed time point for VRE studies (43 weeks). With this restriction, the model-fitted median time to documented clearance for MRSA would occur at 41 weeks after documented colonization, demonstrating the sensitivity of the pooled estimate to length of study follow-up. Conclusions Few available studies report the natural history of MRSA and VRE colonization. Lack of a consistent definition of clearance, uncertainty regarding the time of initial colonization, variation in frequency of sampling for persistent colonization, assays employed and variation in duration of follow-up are limitations of the existing published literature. The heterogeneity of study characteristics limits interpretation of pooled estimates of time to clearance, however, studies included in this review suggest an increase in documented clearance over time, a result which is sensitive to duration of follow-up.
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Affiliation(s)
- Erica S Shenoy
- Division of Infectious Diseases, Infection Control Unit and Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Concordance of PCR and culture from nasal swabs for detection of methicillin-resistant Staphylococcus aureus in a setting of concurrent antistaphylococcal antibiotics. J Clin Microbiol 2014; 52:1235-7. [PMID: 24452168 DOI: 10.1128/jcm.02972-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The effect of concurrent administration of antibiotics on the detection of methicillin-resistant Staphylococcus aureus (MRSA) remains unresolved. Here, we assessed the concordance of paired nasal swabs processed using commercial PCR and culture and found high concordance in both the absence and presence of antibiotics with activity against MRSA (93.7% [95% confidence interval [CI], 88.1%, 96.8%] and 90.9% [95% CI, 84.8%, 94.7%], respectively), although PCR was more likely to be positive in the presence of antibiotics. (This study has been registered at ClinicalTrials.gov under registration no. NCT01234831.).
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Branda JA, Lewandrowski K. Utilization management in microbiology. Clin Chim Acta 2013; 427:173-7. [PMID: 24080434 PMCID: PMC7172269 DOI: 10.1016/j.cca.2013.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 09/20/2013] [Indexed: 11/23/2022]
Abstract
The available literature concerning utilization management in the clinical microbiology laboratory is relatively limited compared with that for high-volume, automated testing in the central Core Laboratory. However, the same strategies employed elsewhere in the clinical laboratory operation can be applied to utilization management challenges in microbiology, including decision support systems, application of evidence-based medicine, screening algorithms and gatekeeper functions. The results of testing in the microbiology laboratory have significant effects on the cost of clinical care, especially costs related to antimicrobial agents and infection control practices. Consequently many of the successful utilization management interventions described in clinical microbiology have targeted not just the volume of tests performed in the laboratory, but also the downstream costs of care. This article will review utilization management strategies in clinical microbiology, including specific examples from our institution and other healthcare organizations. The literature on utilization management in the microbiology laboratory is limited. Utilization management strategies employed in core laboratory can be applied to microbiology. Many utilization interventions in microbiology target the use of antimicrobial agents.
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Affiliation(s)
- John A Branda
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, United States
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