Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-12-01T01:58:57.806Z Has data issue: false hasContentIssue false
  • English
  • Français

Prospective Microbiologic Surveillance in Control of Nosocomial Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Thomas J. Walsh ,
David Vlahov ,
Sharon L. Hansen ,
Edda Sonnenberg ,
Rima Khabbaz ,
Thomas Gadacz  and
Harold C. Standiford
Thomas J. Walsh
Affiliation:
Baltimore Veterans Administration Medical Center, University of Maryland School of MedicineandThe Johns Hopkins University School of Medicine, Baltimore, Maryland
David Vlahov
Affiliation:
Baltimore Veterans Administration Medical Center, University of Maryland School of MedicineandThe Johns Hopkins University School of Medicine, Baltimore, Maryland
Sharon L. Hansen
Affiliation:
Baltimore Veterans Administration Medical Center, University of Maryland School of MedicineandThe Johns Hopkins University School of Medicine, Baltimore, Maryland
Edda Sonnenberg
Affiliation:
Baltimore Veterans Administration Medical Center, University of Maryland School of MedicineandThe Johns Hopkins University School of Medicine, Baltimore, Maryland
Rima Khabbaz
Affiliation:
Baltimore Veterans Administration Medical Center, University of Maryland School of MedicineandThe Johns Hopkins University School of Medicine, Baltimore, Maryland
Thomas Gadacz
Affiliation:
Baltimore Veterans Administration Medical Center, University of Maryland School of MedicineandThe Johns Hopkins University School of Medicine, Baltimore, Maryland
Harold C. Standiford*
Affiliation:
Baltimore Veterans Administration Medical Center, University of Maryland School of MedicineandThe Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Infectious Diseases Section, Veterans Administration Medical Center, 3900 Loch Raven Boulevard, Baltimore, Maryland 21218
Get access Rights & Permissions [Opens in a new window]

Abstract

A prospective microbiological surveillance (PMS) program was developed in a comprehensive hospital-wide effort for control of nosocomial methicillin-resistant Staphylococcus aureus (MRSA). This PMS program entailed: 1) active identification of colonized and infected patients; 2) application of a screening microbiologic system for MRSA; 3) isolation of colonized and infected patients; 4) antibiotic decolonization of MRSA; and 5) educational efforts. The PMS program was studied over three and one half years for its contribution to infection control of MRSA, early identification of nosocomial MRSA outbreaks, use of the highest yield surveillance culture sites, and cost effectiveness. Following initiation of the PMS program in December 1982, during an MRSA outbreak, the frequency of new MRSA cases declined from 14 to none by the end of a 3-month pilot study. The frequency of new MRSA cases stabilized at approximately 2 per month until October 1983, when the PMS system allowed prompt detection of a new outbreak of 11 cases. Following isolation and antibiotic decolonization, the frequency of cases again declined to 3 per month. A third outbreak in December 1985 again was promptly detected and controlled. Infection to colonization ratio decreased from a maximum of 1.5 during outbreaks to a minimum of 0.17 after outbreaks. Wounds and tracheostomy sites provided the greatest yield of detection of new cases of MRSA. During one 15-month period, 35 of the 43 new cases were detected initially at wounds and tracheostomy sites. No new MRSA cases were detected by a positive axillary or nares site alone. The estimated quarterly cost of outbreaks and infection paralleled the quarterly frequency of new MRSA cases. The cost of managing MRSA outbreaks and treating MRSA infections versus the cost of implementing the PMS program suggested that the PMS program may be cost effective. This prospective microbiological surveillance program may be applicable to other institutions for hospital-wide infection control of MRSA.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 8 , Issue 1 , January 1987 , pp. 7 - 14
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1987

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Haley, RN, Hightower, AW, Khabbaz, RF, et al: Emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Ann Intern Med 1982; 97:297–308.Google Scholar
2.Thompson, RL, Cabezudo, I, Wenzel, RP: Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 97:309–316.Google Scholar
3.Lentino, JR, Hennein, H, Krause, S, et al: A comparison of pneumonia caused by gentamicin, methicillin-resistant and gentamicin, methicillin-sensitive Staphylococcus aureus: Epidemiologic and clinical studies. Infect Control 1985; 6:267–272.CrossRefGoogle ScholarPubMed
4.O'Toole, RD, Drew, WL, Dahlgren, BJ, et al: An outbreak of methicillin-resistant Staphylococcus aureus infection: Observations in hospital and nursing home. JAMA 1970; 213:527–563.CrossRefGoogle ScholarPubMed
5.Ward, TT, Winn, RE, Hartstein, AL, et al: Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus infection: Role of antimicrobial therapy in infection control. Infect Control 1981; 2:453–459.Google Scholar
6.Peacock, JE Jr, Marsik, FJ, Wenzel, RP: Methicillin-resistant Staphylococcus aureus: Introduction and spread within a hospital. Ann Intern Med 1980; 93:526–532.CrossRefGoogle ScholarPubMed
7.Crossley, K, Loesch, D, Landesman, B, et al: An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J Infect Dis 1979; 139:273–279.Google Scholar
8.Crossley, K, Landesman, B, Zaski, D: An outbreak of infections caused by strains of S aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies. J Infect Dis 1979; 139:280–287.Google Scholar
9.Boyce, JM: Nosocomial staphylococcal infections. Ann Intern Med 1981; 95:241–242.CrossRefGoogle ScholarPubMed
10.Everett, ED, McNitt, TR, Rahm, AE, et al: Epidemiologic investigation of methicillin-resistant Staphylococcus aureus in a burn unit. Milit Med 1978; 143:165–167.Google Scholar
11.Boyce, JM, Landry, M, Deetz, TR, et al: Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control 1981; 2:110–116.Google Scholar
12.Dunkle, LM, Naqvi, SH, McCallum, R, et al: Eradication of epidemic methicillin-gentamicin-resistant Staphylococcus aureus in an intensive care nursery. Am J Med 1981; 70:455–458.Google Scholar
13.Klimek, JJ, Marsik, FJ, Bartlett, RC, et al: Clinical epidemiologic and bacteriologie observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Am J Med 1976; 61:340–345.CrossRefGoogle Scholar
14.Saroglou, G, Cromer, M, Bisno, AL: Methicillin-resistant Staphylococcus aureus: Interstate spread of nosocomial infections with emergence of gentamicin-methicillin resistant strains. Infect Control 1980; 1:80–89.Google Scholar
15.Locksley, RM, Cohen, ML, Quinn, TC, et al: Multiply antibiotic-resistant Staphylococcus aureus: Introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982; 97:317–324.Google Scholar
16.Boyce, JM, Landry, M, Deetz, TR, et al: Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control 1981; 70:455–458.Google Scholar
17.Ward, TT, Winn, RE, Hartstein, AL, et al: Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: Role of antimicrobial therapy in infection control. Infect Control 1981; 2:453–459.Google Scholar
18.Haley, RW, Quade, D, Freeman, HE, et al: Study on the efficacy of nosocomial infection control (SENIC project): Summary of study design. Am J Epidemiol 1980; 3:472–485.Google Scholar
19.Smith, SM, Berezny, C: Comparative evaluation of identification systems for testing methicillin-resistant strains of Staphylococcus aureus. J Clin Microbiol 1986; 24:173–176.CrossRefGoogle ScholarPubMed
20.National Committee for Clinical Laboratory Standards: 1984 Performance standards for antimicrobial disk susceptibility test, ed 3. Approved standard M2-A3. National Committee for Clinical Laboratory Standards, Villanova, PA.Google Scholar
21.Hansen, SL, Freedy, PK: Variation in the abilities of automated, commercial and reference methods to detect methicillin-resistant (heteroresistant) Staphylococcus aureus. J Clin Microbiol 1984; 20:494–499.CrossRefGoogle ScholarPubMed
22.Rimland, D, Roberson, B: Gastrointestinal carnage of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1986; 24:137–138.Google Scholar
23.Walsh, TJ, Auger, FA, Tatem, BE, et al: In vitro activity of novobiocin and rifampin in combination against methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 1986; 17:75.Google Scholar
24.Bryan, CS, Wilson, RS, Meade, P, et al: Topical antibiotic ointments for staphylococcal nasal carriers: Survey of current practices and comparison of bacitracin and vancomycin ointments. Infect Control 1980; 1:153–156.CrossRefGoogle ScholarPubMed
25.Bartzokas, CA, Paton, JH, Gibson, MR, et al: Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med 1984; 311:1422–1425.CrossRefGoogle ScholarPubMed