Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial

被引:40
作者
Lee, Andie S. [1 ,2 ,3 ,4 ]
Cooper, Ben S. [5 ,6 ]
Malhotra-Kumar, Surbhi [7 ]
Chalfine, Annie [8 ]
Daikos, George L. [9 ]
Fankhauser, Carolina [1 ,2 ]
Carevic, Biljana [10 ]
Lemmen, Sebastian [11 ]
Antonio Martinez, Jose [12 ]
Masuet-Aumatell, Cristina [13 ,14 ]
Pan, Angelo [15 ]
Phillips, Gabby [16 ]
Rubinovitch, Bina [17 ]
Goossens, Herman [7 ]
Brun-Buisson, Christian [18 ,19 ]
Harbarth, Stephan [1 ,2 ]
机构
[1] Univ Geneva Hosp, Infect Control Program, Geneva, Switzerland
[2] Fac Med, Geneva, Switzerland
[3] Royal Prince Alfred Hosp, Dept Infect Dis, Sydney, NSW, Australia
[4] Royal Prince Alfred Hosp, Dept Microbiol, Sydney, NSW, Australia
[5] Mahidol Univ, Fac Trop Med, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand
[6] Univ Oxford, Nuffield Dept Clin Med, Ctr Clin Vaccinol & Trop Med, Oxford, England
[7] Univ Antwerp, Vaccine & Infect Dis Inst, Dept Med Microbiol, Antwerp, Belgium
[8] Grp Hosp Paris St Joseph, Infect Control Unit, Paris, France
[9] Laikon Gen Hosp, Dept Propaedeut Med 1, Athens, Greece
[10] Clin Ctr Serbia, Dept Hosp Epidemiol, Belgrade, Serbia
[11] Univ Klinikum Aachen, Dept Infect Control & Infect Dis, Aachen, Germany
[12] Hosp Clin Barcelona, Infect Dis Serv, Barcelona, Spain
[13] Univ Hosp Bellvitge, Prevent Med Dept, Bellvitge Biomed Res Inst IDIBELL, Barcelona, Spain
[14] Univ Hosp Bellvitge, Fac Med, Bellvitge Biomed Res Inst IDIBELL, Barcelona, Spain
[15] Ist Ospitalieri Cremona, Infect & Trop Dis Unit, Cremona, Italy
[16] Ninewells Hosp, Infect Control Dept, Dundee DD1 9SY, Scotland
[17] Beilinson Med Ctr, Rabin Med Ctr, Unit Infect Control, Petah Tikwa, Israel
[18] Inst Pasteur, INSERM, U657, F-75724 Paris, France
[19] Univ Paris Est Creteil, Dept Intens Care, Hop Henri Mondor, Creteil, France
来源
BMJ OPEN | 2013年 / 3卷 / 09期
关键词
ACTIVE SURVEILLANCE CULTURES; RAPID SCREENING-TESTS; SITE INFECTIONS; HAND HYGIENE; NOSOCOMIAL INFECTION; HOSPITAL ADMISSION; MRSA; CARE; BACTEREMIA; PREVENTION;
D O I
10.1136/bmjopen-2013-003126
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To compare the effect of two strategies (enhanced hand hygiene vs meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonisation) alone and in combination on MRSA rates in surgical wards. Design: Prospective, controlled, interventional cohort study, with 6-month baseline, 12-month intervention and 6-month washout phases. Setting: 33 surgical wards of 10 hospitals in nine countries in Europe and Israel. Participants: All patients admitted to the enrolled wards for more than 24 h. Interventions: The two strategies compared were (1) enhanced hand hygiene promotion and (2) universal MRSA screening with contact precautions and decolonisation (intranasal mupirocin and chlorhexidine bathing) of MRSA carriers. Four hospitals were assigned to each intervention and two hospitals combined both strategies, using targeted MRSA screening. Outcome measures: Monthly rates of MRSA clinical cultures per 100 susceptible patients (primary outcome) and MRSA infections per 100 admissions (secondary outcome). Planned subgroup analysis for clean surgery wards was performed. Results: After adjusting for clustering and potential confounders, neither strategy when used alone was associated with significant changes in MRSA rates. Combining both strategies was associated with a reduction in the rate of MRSA clinical cultures of 12% per month (adjusted incidence rate ratios (aIRR) 0.88, 95% Cl 0.79 to 0.98). In clean surgery wards, strategy 2 (MRSA screening, contact precautions and decolonisation) was associated with decreasing rates of MRSA clinical cultures (15% monthly decrease, aIRR 0.85, 95% Cl 0.74 to 0.97) and MRSA infections (17% monthly decrease, aIRR 0.83, 95% Cl 0.69 to 0.99). Conclusions: In surgical wards with relatively low MRSA prevalence, a combination of enhanced standard and MRSA-specific infection control approaches was required to reduce MRSA rates. Implementation of single interventions was not effective, except in clean surgery wards where MRSA screening coupled with contact precautions and decolonisation was associated with significant reductions in MRSA clinical culture and infection rates.
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页数:18
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