Control of meticillin-resistant Staphylococcus aureus in a higly endemic setting: a 6-year experience in a teaching hospital in Slovenia
Abstract number: P1767
Tomic V., Svetina Sorli P., Novak M.
Introduction: Endemic MRSA increases morbidity, length of hospital stay and hospital costs. In 2002, we introduced a comprehensive infection control programme (ICP) to reduce the hospital transmission of MRSA in our 230-bed tertiary care, teaching hospital in Slovenia where MRSA has become endemic.
Methods: The ICP includes use of alcohol handrub, active surveillance cultures on admission to identify MRSA carriers, barrier precautions for patients with MRSA, and eradication (decolonisation) of MRSA carriage. Selective screening was routinly performed within 72 hours of hospital admission in all patients with risk factors for MRSA carriage. Surveillance cultures performed were always obtained from the nose and throat. Additionally swabs from open wounds (when present), urine samples (when urinary catheter present >24 hours) or tracheal aspirate (intubated patients were obtained. MRSA carriers were placed in a single room, cohorted or at least 1 m between patients' beds was ensured. Gloves and gowns were required for all contacts with carriers or their environment. Masks were required only when caring for patients with MRSA in the respiratory tract or wound.
Results: During the 6 years 42946 patients were admitted to our hospital. Growth of S. aureus was detected from at least 1 specimen in 2411 (0.6%) patients. Of these, 253 (10.5%) were colonised with MRSA; 70.4% were men. Two hundred fourteen MRSA cases (84.6%) were imported, and 39 (15.4%) were acquired in our hospital. In the ICU 50 MRSA carriers were detected (19.8% all MRSA carriers). Of these, 39 (78%) patients were already colonised on admission, and 11 (22%) patients acquired MRSA during the stay in our ICU. The proportion of MRSA cases acquired in our hospital declined from 35% in 2001 to 6.1% in 2002, whereas proportion of imported MRSA cases increased from 65% to 93.9%. From 2003 to 2006 the proportions of MRSA cases acquired in our hospital were 18.3%, 16.7%, 6.0, and 5.7%, respectively. Patients with imported MRSA carriage (214 cases) were transfered from other hospitals (30.4%), nursing homes (13.6%), and rehabilitation centre (0.9%) or were hospitalised at least once in the past 3 years prior to admission to our hospital (55.1%).
Conclusions: With a comprehensive ICP it is possible to reduce nosocomial transmissions of MRSA and keep them that way. A two-year increase in the number of MRSA cases acquired in our hospital was mainly due to lapses in active surveillance procedures.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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