Skip to main content
×
Home
    • Aa
    • Aa

Sustained Reduction in the Clinical Incidence of Methicillin-Resistant Staphylococcus aureus Colonization or Infection Associated with a Multifaceted Infection Control Intervention

  • Katherine Ellingson (a1), Robert R. Muder (a2), Rajiv Jain (a2), David Kleinbaum (a1), Pei-Jean I. Feng (a1), Candace Cunningham (a2), Cheryl Squier (a2), Jon Lloyd (a2), Jonathan Edwards (a1), Val Gebski (a3) and John Jernigan (a1)...
Abstract
Objective.

To assess the impact and sustainability of a multifaceted intervention to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission implemented in 3 chronologically overlapping phases at 1 hospital.

Design.

Interrupted time-series analyses.

Setting.

A Veterans Affairs hospital in the northeastern United States.

Patients and Participants.

Individuals admitted to acute care units from October 1, 1999, through September 30, 2008. To calculate the monthly clinical incidence of MRSA colonization or infection, the number of MRSA-positive cultures obtained from a clinical site more than 48 hours after admission among patients with no MRSA-positive clinical cultures during the previous year was divided by patient-days at risk. Secondary outcomes included clinical incidence of methicillin-sensitive S. aureus colonization or infection and incidence of MRSA bloodstream infections.

Interventions.

The intervention—implemented in a surgical ward beginning October 2001, in a surgical intensive care unit beginning October 2003, and in all acute care units beginning July 2005—included systems and behavior change strategies to increase adherence to infection control precautions (eg, hand hygiene and active surveillance culturing for MRSA).

Results.

Hospital-wide, the clinical incidence of MRSA colonization or infection decreased after initiation of the intervention in 2001, compared with the period before intervention (P = .002), and decreased by 61% (P < .001) in the 7-year postintervention period. In the postintervention period, the hospital-wide incidence of MRSA bloodstream infection decreased by 50% (P = .02), and the proportion of S. aureus isolates that were methicillin resistant decreased by 30% (P < .001).

Conclusions.

Sustained decreases in hospital-wide clinical incidence of MRSA colonization or infection, incidence of MRSA bloodstream infection, and proportion of S. aureus isolates resistant to methicillin followed implementation of a multifaceted prevention program at one Veterans Affairs hospital. Findings suggest that interventions designed to prevent transmission can impact endemic antimicrobial resistance problems.

Copyright
Corresponding author
Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, 1600 Clifton Road NE, MS A-31, Atlanta, GA 30333 (kellingson@cdc.gov)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

3. B Spellberg , R Guidos , D Gilbert , et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 2008;46(2):155164.

4. A Hidron , CE Low , EG Honig , HM Blumberg . Emergence of community-acquired methicillin-resistant Staphylococcus aureus strain USA300 as a cause of necrotising community-onset pneumonia. Lancet Infect Dis 2009;9(6):384392.

5. RM Klevens , JR Edwards , FC Tenover , LC McDonald , T Horan , R Gaynes . Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42(3):389391.

6. MJ Kuehnert , HA Hill , BA Kupronis , JI Tokars , SL Solomon , DB Jernigan . Methicillin-resistant-Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11(6):868872.

7. RM Klevens , MA Morrison , J Nadle , et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):17631771.

8. JA Jernigan , MA Clemence , GA Stott , et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16(12):686696.

9. M Melzer , SJ Eykyn , WR Gransden , S Chinn . Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus?. A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 2003;37(11):14531460.

11. SE Cosgrove , G Sakoulas , EN Perencevich , MJ Schwaber , AW Karchmer , Y Carmeli . Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36(1):5359.

12. WC Albrich , S Harbarth . Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008;8(5):289301.

13. SS Huang , DS Yokoe , VL Hinrichsen , et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43(8):971978.

14. A Robksek , JL Beaumont , SM Paule , et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409418.

15. DC Burton , JR Edwards , TC Horan , JA Jernigan , SK Fridkin . Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA 2009;301(7):727736.

20. SS Huang , SL Rifas-Shiman , DK Warren , et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195(3):330338.

23. AK Wagner , SB Soumerai , F Zhang , D Ross-Degnan . Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27(4):299309.

24. J Durbin , GS Watson . Testing for serial correlation in least squares regression. II. Biometrika 1951;38(1-2):159178.

25. S Harbarth , C Fankhauser , J Schrenzel , et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299(10):11491157.

26. M Pujol , C Pena , R Pallares , et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-suceptible strains. Am J Med 1996;100(5):509516.

27. JA Jernigan , AL Pullen , L Flowers , M Bell , WR Jarvis . Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003;24(6):409414.

28. RJ Gorwitz , D Kruszon-Moran , SK McAllister , et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008;197(9):12261234.

29. FC Tenover , SK McAllister , G Fosheim , et al. Characterization of Staphylococcus aureus isolates from nasal cultures collected from individuals in the United States in 2001 to 2004. J Clin Microbiol 2008;46(9):28372841.

30. M Lipsitch , CT Bergstrom , BR Levin . The epidemiology of antibiotic resistance in hospitals: paradoxes and prescriptions. Proc Natl Acad Sci USA 2000;97(4):19381943.

31. BS Cooper , GF Medley , SP Stone , et al. Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 2004;101(27):1022310228.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 17 *
Loading metrics...

Abstract views

Total abstract views: 108 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th August 2017. This data will be updated every 24 hours.