CONTROL OF NOSOCOMIAL SPREAD OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)
Background. This prospective cohort study presents the effectiveness and feasibility of a comprehensive control strategy to reduce nosocomial transmission of methicillinresistant Staphylococcus aureus (MRSA) in a highly endemic setting.
Methods. All patients with MRSA carriage admitted to the University Clinic of Respiratory and Allergic Diseases over a period of 5 years (January 1998 through December 2002) were included and categorized into imported or hospitalacquired cases. In January 1999, an aggressive infection control program was implemented. It was focused on promoting alcohol hand rub, obtaining active surveillance cultures for MRSA, implementing strict barrier precautions and decolonizing MRSA carriers.
Results. MRSA was recovered from 223 hospitalized patients; 142 cases were imported and 81 were acquired at our institution. After the introduction of an active surveillance program, the annual incidence of detected MRSA carriage per 1000 admissions first increased from 4.5 in 1998 to 8.0 in 1999 (p = 0.019), but remained stable thereafter. The proportion of patients detected through active surveillance cultures progressively increased from 23% in 1999 to 78% in 2002. Since 1999, the proportion of acquired MRSA cases in our institution has steadily decreased from 50% in 1999 to 6% in 2002 (p < 0.001), whereas the proportion of patients who acquired MRSA in other hospitals (p < 0.001) and nursing homes (p = 0.025) has increased.
Conclusions. With a comprehensive infection control program it is possible to substantially reduce nosocomial transmission of MRSA in a highly endemic area. With good hand hygiene, early detection, isolation and decolonization strategy, containment of MRSA is achievable despite a high rate of transferred patients colonized or infected with MRSA from other healthcare facilities.
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