Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-23T08:20:15.863Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) acquisition during ambulance transport: A retrospective propensity-score–matched cohort analysis

Published online by Cambridge University Press:  21 July 2021

Diego Schaps Open the ORCID record for Diego Schaps [Opens in a new window] ,
Andrew W. Godfrey  and
Deverick J. Anderson
Diego Schaps
Affiliation:
School of Medicine, Duke University, Durham, North Carolina
Andrew W. Godfrey
Affiliation:
Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
Deverick J. Anderson*
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
*
Author for correspondence: Deverick J. Anderson, E-mail: deverick.anderson@duke.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To estimate the relative risk (RR) of developing methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection within 30 days of ambulance transport.

Methods:

We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) over a 4-year period. Patients were included if they presented from and were discharged to nonhealthcare locations without being admitted. Encounters were stratified by arrival mechanism: ambulance versus private vehicle. We performed propensity score matching and multivariable logistic regression to estimate the RR for the primary outcome.

Results:

In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score matching, there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Among them, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalence of MRSA or VRE was larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09–12.71; P = .04).

Conclusions:

Our cohort study is the first to demonstrate an association between ambulance exposure and pathogen incidence, representing the first step in evaluating medical-transport–associated infection burden to eventually develop interventions to address it.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 4 , April 2022 , pp. 442 - 447
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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.)

Footnotes

PREVIOUS PRESENTATION: This study was accepted in abstract form for a poster presentation at The Society for Healthcare Epidemiology of America (SHEA) Spring Conference, which took place virtually April 13–16, 2021.

References

Schaps, D, Joiner, AP, Anderson, DJ. Medical transport-associated infection: review and commentary making a case for its legitimacy. Infect Control Hosp Epidemiol 2020. doi: 10.1017/ice.2020.1354.CrossRefGoogle Scholar
Bledsoe, BE, Sweeney, RJ, Berkeley, RP, Cole, KT, Forred, WJ, Johnson, LD. EMS provider compliance with infection control recommendations is suboptimal. Prehosp Emerg Care 2014;18:290–294.CrossRefGoogle ScholarPubMed
Gibson, CV. Emergency medical services oxygen equipment: a fomite for transmission of MRSA? Emerg Med J 2019;36:89–91.Google ScholarPubMed
O’Hara, NB, Reed, HJ, Afshinnekoo, E, et al. Metagenomic characterization of ambulances across the USA. Microbiome 2017;5:125.CrossRefGoogle ScholarPubMed
Teter, J, Millin, MG, Bissell, R. Hand hygiene in emergency medical services. Prehosp Emerg Care 2015;19:313–319.CrossRefGoogle ScholarPubMed
Vikke, HS, Giebner, M, Kolmos, HJ. Prehospital infection control and prevention in Denmark: a cross-sectional study on guideline adherence and microbial contamination of surfaces. Scand J Trauma Resusc Emerg Med 2018;26:71.CrossRefGoogle ScholarPubMed
Vikke, HS, Vittinghus, S, Giebner, M, et al. Compliance with hand hygiene in emergency medical services: an international observational study. Emerg Med J 2019;36:171–175.CrossRefGoogle Scholar
Emanuelsson, L, Karlsson, L, Castrèn, M, Lindström, V. Ambulance personnel adherence to hygiene routines: still protecting ourselves but not the patient. Eur J Emerg Med 2013;20:281–285.CrossRefGoogle Scholar
Khan, AA. Emergency medical services providers’ experiences and attitudes toward infection prevention and control measures in Saudi Arabia: a qualitative study. Disaster Med Public Health Prep 2020;14:713–718.CrossRefGoogle ScholarPubMed
Rui, P, Kang, K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables, in National Center for Health Statistics Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf. Published 2017. Accessed June 16, 2021.Google Scholar
Bland, M. An Introduction to Medical Statistics, Fourth ed. Oxford, UK: Oxford University Press; 2015.Google Scholar
Hosmer, DW. Applied Logistic Regression. Third ed. Hoboken, NJ: Wiley; 2013.CrossRefGoogle Scholar
Haukoos, JS, Lewis, RJ. The propensity score. JAMA 2015;314:1637–1638.CrossRefGoogle ScholarPubMed
Stuart, EA. Matching methods for causal inference: a review and a look forward. Stat Sci 2010;25:1–21.CrossRefGoogle Scholar
Alter, SM, Merlin, MA. Nosocomial and community-acquired infection rates of patients treated by prehospital advanced life support compared with other admitted patients. Am J Emerg Med 2011;29:57–64.CrossRefGoogle ScholarPubMed
Orellana, RC, Hoet, AE, Bell, C, et al. Methicillin-resistant Staphylococcus aureus in Ohio EMS providers: a statewide cross-sectional study. Prehosp Emerg Care 2016;20:184–190.CrossRefGoogle Scholar
Al Amiry, A, Bissell, RA, Maguire, BJ, Alves, DW. Methicillin-resistant Staphylococcus aureus nasal colonization prevalence among emergency medical services personnel. Prehosp Disaster Med 2013;28:348–352.CrossRefGoogle ScholarPubMed
Miramonti, C, Rinkle, JA, Iden, S, et al. The prevalence of methicillin-resistant staphylococcus aureus among out-of-hospital care providers and emergency medical technician students. Prehosp Emerg Care 2013;17:73–77.CrossRefGoogle ScholarPubMed
Ro, YS, Shin, SD, Noh, H, Cho, SI. Prevalence of positive carriage of tuberculosis, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci in patients transported by ambulance: a single center observational study. J Prev Med Public Health 2012;45:174–180.CrossRefGoogle ScholarPubMed