Is it worthwhile to control methicillin-resistant Staphylococcus aureus in a highly endemic country? A9year experience in a Portuguese hospital
Abstract number: P1542
Gonçalves M.L., Costa A., Narciso J., Afonso L., Hipolito C., Neto O., Correia A.B., Fernandes F., Canudo A., Santos Costa A., Pedro P., Gasparinho C., Ferreira F., Mato R., Sanches I., de Lencastre H.
Objective: To evaluate the impact of a prolonged comprehensive control program for methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization, in a Hospital located in a country with a very high MRSA prevalence.
Methods: Hospital SAMS is a 121-bed acute-care private hospital in Lisbon, Portugal, serving a population of 122,000 that also uses other healthcare institutions. MRSA has been endemic in SAMS since at least 1997, representing almost 50% of all S. aureus isolates. Medical and surgical wards and medical-surgical intensive care unit (ICU) were the most affected. After a baseline study period (19971999), an infection control program was launched in 2000 in these units. It included screening cultures (universal screening in ICU and screening of high-risk patients in the selected wards), use of contact-droplets precautions, appropriate hand hygiene and decolonization of colonized patients.
The program was available for evaluation during three time periods: Period 1 (20002003) full implementation of the program; Period 2 (20042005) adherence to the program was progressively discontinued; Period 3 (2006-June 09) reimplementation of the full-program plus screening of high-risk patients at hospital admission. An analysis comparing the incidence rate of hospital-acquired MRSA infections per 1,000 patient-days in the different intervention periods was carried out.
Results: Patients infected or colonized with MRSA have been admitted to the Hospital since the beginning of the program. Of the 2,327 patients screened at admission in ICU (2000-Jun2009) 2.8% were colonized. In Period 3 from the 833 high-risk patients screened at Hospital admission 14.4% were colonized. The majority came from nursing homes or other Hospitals. The baseline rate of hospital-acquired MRSA infections in ICU was 4.56 infections per 1,000 patient-days and decreased to 0.83 (P = 0.02) and to 0 (P < 0.001) in periods 1 and 3 respectively. The global baseline rate of hospital-acquired MRSA infections in the three units was 0.57 and decreased to 0.15 in periods 1 and 3 (P < 0.001). In contrast, there was an increase of hospital-acquired MRSA infections in all units during Period 2.
Conclusions: A comprehensive program to control MRSA infection and colonization can be successful even in a highly endemic area and can be sustained for a prolonged period. Motivation, education and feedback are some of the most important tools for the sustainability of such a control policy.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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