Incidence, prevalence, and management of MRSA bacteremia across patient populations

A review of recent developments in MRSA management and treatment | Critical Care

B0006889 MRSA

Image source: Annie Cavanagh – Wellcome Images // CC BY-NC 4.0

Image shows clusters of methicillin-resistant Staphylococcus aureus bacteria.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is still a major global healthcare problem. Of concern is S. aureus bacteremia, which exhibits high rates of morbidity and mortality and can cause metastatic or complicated infections such as infective endocarditis or sepsis. MRSA is responsible for most global S. aureus bacteremia cases, and compared with methicillin-sensitive S. aureus, MRSA infection is associated with poorer clinical outcomes. S. aureus virulence is affected by the unique combination of toxin and immune-modulatory gene products, which may differ by geographic location and healthcare- or community-associated acquisition.

Management of S. aureus bacteremia involves timely identification of the infecting strain and source of infection, proper choice of antibiotic treatment, and robust prevention strategies. Resistance and nonsusceptibility to first-line antimicrobials combined with a lack of equally effective alternatives complicates MRSA bacteremia treatment.

This review describes trends in epidemiology and factors that influence the incidence of MRSA bacteremia. Current and developing diagnostic tools, treatments, and prevention strategies are also discussed.

Full reference: Hassoun, A. et al. (2017) Incidence, prevalence, and management of MRSA bacteremia across patient populations—a review of recent developments in MRSA management and treatment. Critical Care. 21:211

Exposure to information and seasonal influenza vaccination uptake in nurses

Coverage of annual influenza vaccination of healthcare workers (HCWs) varies and remains at a sub-optimal level in many countries | Journal of Hospital Infection

syringe-1696020_960_720

As HCWs are often exposed to a variety of information on vaccination, their pattern of exposure may impact their decision, which deserves further investigation.

Practising nurses in Hong Kong were invited to participate in an anonymous online survey in February 2015, after the winter seasonal peak. The questionnaire covered demographics, work nature and experiences, vaccination uptake history and reasons for vaccination decisions. Two categories of behaviors with regards to information access were defined – (A) passive exposure to information, and (B) active information-seeking, as differentiated by the source, type and nature of information accessed. Chi-square test, Mann-Whitney U test, logistic regression were performed to compare between vaccinated and unvaccinated nurses.

A total of 1177 valid returns were received from nurses who had a median age of 32, of whom 86% were female. The overall vaccination rate was 33%. Passive exposure to information from workplace, professional body and social network did not predict vaccination decision, while mass media did (OR:1.78). Active information-seeking involving consulting seniors (OR:2.46), having organized promotion activities (OR:2.85) and performing information search (OR:2.43) were significantly associated with increased vaccination uptake. Cumulative effect could be demonstrated for active information seeking (OR:1.86) but not passive exposure to information.

Current strategy of promotions and campaigns for seasonal influenza vaccination in HCWs may not be effective in increasing vaccination coverage. Measures targeting information-seeking behaviors may serve as an alternative approach.

Full reference: Cheung, E.K.H. et al. (2017) Pattern of exposure to information and its impacts on seasonal influenza vaccination uptake in nurses. Journal of Hospital Infection. Published online: 11 August 2017

Candida auris: infection control in community care settings

This guidance prescribes infection control measures for community care settings where service users have been colonised with C. auris | PHE

thumbnail_c-_auris_in_community_settings_v1-0-pdf

This guidance – for nursing homes and other community care settings – covers infection control precautions, including maintenance of cleaning standards and other special precautions appropriate when service users are, or have been, colonised with C. auris.

Read the full guidance here

Hand hygiene compliance in a universal gloving setting

The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions | American Journal of Infection Control

https://www.flickr.com/photos/mikecogh/20464487373

Image source: Michael Coghlan – Flickr // CC BY-SA 2.0

Background: The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting.

Methods: This nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital.

Results: A total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus.

Conclusion: It is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.

Full reference: Kuruno, N. et al. (2017) Hand hygiene compliance in a universal gloving setting. American Journal of Infection Control. Vol. 45 (Issue 8) pp. 830–834

Staff nurses as antimicrobial stewards

An integrative literature review | American Journal of Infection Control

Background: Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored.

Methods: An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis.

Results: Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management.

Discussion: Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce.

Full reference: Monsees, E. et al. (2017) Staff nurses as antimicrobial stewards: An integrative literature review. American Journal of Infection Control. Vol. 45 (no. 8) pp. 917–922

Reducing catheter-associated urinary tract infections in the ICU

This review provides a summary of CAUTI reduction strategies that are specific to the intensive care setting | Current Opinion in Critical Care

Purpose of review: Patients in the ICU are at higher risk for catheter-associated urinary tract infection (CAUTI) due to more frequent use of catheters and lower threshold for obtaining urine cultures.

Recent findings: The surveillance definition for CAUTI is imprecise and measures catheter-associated bacteriuria rather than true infection. Alternatives have been proposed, but CAUTI rates measured by this definition are currently required to be reported to the Centers for Medicare and Medicaid Services and high CAUTI rates can result in financial penalties. Although CAUTI may not directly result in significant patient harm, it has several indirect patient safety implications and CAUTI reduction has several benefits. Various bundles have been successful at reducing CAUTI both in individual institutions and on larger scales such as healthcare networks and entire states.

Summary: CAUTI reduction is possible in the ICU through a combination of reduced catheter usage, improved catheter care and stewardship of urine cultures.

Full reference: Sampathkumar, P. (2017) Reducing catheter-associated urinary tract infections in the ICU. Current Opinion in Critical Care: Published online: 28 July 2017

No-touch methods of terminal cleaning in the intensive care unit

Results from the first large randomized trial with patient-centred outcomes | Critical Care

Environmental contamination may play a major role in intensive care unit (ICU)-acquired infections, despite current terminal cleaning standards. Anderson et al. recently performed the first large randomized trial investigating a no-touch method of terminal cleaning with a patient-centred outcome, and provided more robust data on the role of environmental contamination for healthcare-associated infections. The authors evaluated three different enhanced terminal disinfection methods (ultraviolet, UV light, UV light plus bleach, and bleach) compared to the reference standard for prevention of transmission of multidrug resistant organisms (MDROs) and Clostridium difficile to patients exposed to a room whose prior occupant was either colonized or infected with a MDRO.

Full reference: Russotto, V. et al. (2017) No-touch methods of terminal cleaning in the intensive care unit: results from the first large randomized trial with patient-centred outcomes. Critical Care. 21:117.