PURPOSE: To determine whether any of several quality improvement interventions with none specifically targeting methicillin-resistant Staphylococcus aureus (MRSA) were associated with a decline in endemic MRSA prevalence in an intensive care unit (ICU) where active screening and contact isolation precautions for known MRSA colonised patients are not practised. SETTING: Medical-surgical ICU with 2,000 admissions/year. DESIGN: 8.5-year retrospective time-series analysis. INTERVENTIONS: ICU re-location, antibiotic stewardship utilising computerised decision-support and infectious-diseases physician rounds, dedicated ICU infection control practitioners, alcohol-based hand rub solution (ABHRS). METHOD: Regression modelling was used to evaluate trends in S. aureus prevalence density (monthly clinical isolates per 1,000 patient-days), antibiotic consumption, infection control consumables, ABHRS and their temporal relationship with MRSA prevalence. RESULTS: Methicillin-resistant S. aureus prevalence density decreased by 83% [95% confidence interval (CI) -68% to -91%, p < 0.001]. Rates of MRSA bacteraemia decreased 89% (95% CI -79% to -94%, p = 0.001) with no statistically significant change in methicillin-sensitive S. aureus bacteraemia. Hospital MRSA prevalence density decreased 17% (95% CI -5% to -27%, p = 0.005), suggesting that ICU was not shifting MRSA elsewhere. In ICU, broad-spectrum antibiotic use decreased by 26% (95% CI -12% to -38%, p = 0.008), coinciding with a decrease in MRSA, but time-series analysis did not show a significant association. On multivariate analysis, only ABHRS was significantly associated with a decrease in MRSA, but it was formally introduced late in the study period when MRSA was already in decline. CONCLUSION: General quality improvement measures were associated with a decrease in endemic MRSA in a high-risk setting without use of resource-intensive active surveillance and isolation practices.
PURPOSE: To determine whether any of several quality improvement interventions with none specifically targeting methicillin-resistant Staphylococcus aureus (MRSA) were associated with a decline in endemic MRSA prevalence in an intensive care unit (ICU) where active screening and contact isolation precautions for known MRSA colonised patients are not practised. SETTING: Medical-surgical ICU with 2,000 admissions/year. DESIGN: 8.5-year retrospective time-series analysis. INTERVENTIONS: ICU re-location, antibiotic stewardship utilising computerised decision-support and infectious-diseases physician rounds, dedicated ICU infection control practitioners, alcohol-based hand rub solution (ABHRS). METHOD: Regression modelling was used to evaluate trends in S. aureus prevalence density (monthly clinical isolates per 1,000 patient-days), antibiotic consumption, infection control consumables, ABHRS and their temporal relationship with MRSA prevalence. RESULTS:Methicillin-resistant S. aureus prevalence density decreased by 83% [95% confidence interval (CI) -68% to -91%, p < 0.001]. Rates of MRSA bacteraemia decreased 89% (95% CI -79% to -94%, p = 0.001) with no statistically significant change in methicillin-sensitive S. aureus bacteraemia. Hospital MRSA prevalence density decreased 17% (95% CI -5% to -27%, p = 0.005), suggesting that ICU was not shifting MRSA elsewhere. In ICU, broad-spectrum antibiotic use decreased by 26% (95% CI -12% to -38%, p = 0.008), coinciding with a decrease in MRSA, but time-series analysis did not show a significant association. On multivariate analysis, only ABHRS was significantly associated with a decrease in MRSA, but it was formally introduced late in the study period when MRSA was already in decline. CONCLUSION: General quality improvement measures were associated with a decrease in endemic MRSA in a high-risk setting without use of resource-intensive active surveillance and isolation practices.
Authors: R Monina Klevens; Jonathan R Edwards; Fred C Tenover; L Clifford McDonald; Teresa Horan; Robert Gaynes Journal: Clin Infect Dis Date: 2005-12-19 Impact factor: 9.079
Authors: Klaus Kaier; Christian Hagist; Uwe Frank; Andreas Conrad; Elisabeth Meyer Journal: Infect Control Hosp Epidemiol Date: 2009-04 Impact factor: 3.254
Authors: Paul D R Johnson; Rhea Martin; Laurelle J Burrell; Elizabeth A Grabsch; Susan W Kirsa; Jason O'Keeffe; Barrie C Mayall; Deidre Edmonds; Wendy Barr; Christopher Bolger; Humsha Naidoo; M Lindsay Grayson Journal: Med J Aust Date: 2005-11-21 Impact factor: 7.738
Authors: George G Zhanel; Mel DeCorby; Nancy Laing; Barb Weshnoweski; Ravi Vashisht; Franil Tailor; Kim A Nichol; Aleksandra Wierzbowski; Patricia J Baudry; James A Karlowsky; Philippe Lagacé-Wiens; Andrew Walkty; Melissa McCracken; Michael R Mulvey; Jack Johnson; Daryl J Hoban Journal: Antimicrob Agents Chemother Date: 2008-02-19 Impact factor: 5.191
Authors: K L Buising; K A Thursky; M B Robertson; J F Black; A C Street; M J Richards; G V Brown Journal: J Antimicrob Chemother Date: 2008-06-11 Impact factor: 5.790
Authors: Peter Davey; Charis A Marwick; Claire L Scott; Esmita Charani; Kirsty McNeil; Erwin Brown; Ian M Gould; Craig R Ramsay; Susan Michie Journal: Cochrane Database Syst Rev Date: 2017-02-09
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; Herwig Gerlach; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2011-01-12 Impact factor: 17.440
Authors: Tjibbe Donker; Sandra Reuter; James Scriberras; Rosy Reynolds; Nicholas M Brown; M Estée Török; Richard James; East Of England Microbiology Research Network; David M Aanensen; Stephen D Bentley; Matthew T G Holden; Julian Parkhill; Brian G Spratt; Sharon J Peacock; Edward J Feil; Hajo Grundmann Journal: Microb Genom Date: 2017-07-04