Researchers Find Door Handles to Be Significant Source of MRSA in Hospitals

The aim of this study by Saba, et al. (2017) was to determine the prevalence and antibiotic susceptibility of S. aureus and methicillin-resistant S. aureus (MRSA) in the environments of three hospitals in Ghana | Infection Control Today

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A total of 120 swab samples were taken from door handles, stair railings and other points of contact at Tamale Teaching Hospital, Tamale Central Hospital and Tamale West Hospital. The swab samples were directly plated on Mannitol Salt and Baird Parker agar plates and incubated at 37 °C (± 2) for 18 to 24 hours. An antibiotic susceptibility test was performed using the Clinical Laboratory Standard Institute’s guidelines. Isolates resistant to both cefoxitin and oxacillin were considered to be MRSA.

The researchers conclude that the high multi-drug resistance of MRSA in hospital environments in Ghana reinforces the need for the effective and routine cleaning of door handles in hospitals. Further investigation is required to understand whether S. aureus from door handles could be the possible causes of nosocomial diseases in the hospitals.

Read the full overview via Infection Control here

The original research abstract is available here

Collaboration with an infection control team for patients with infection after spine surgery

Kobayashi, K. et al. American Journal of Infection Control. Published online: 22 February 2017

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Highlights: 

  • The risk of infection after spine surgery has increased due to aging of society.
  • An infection control team (ICT) manages infected cases at our hospital.
  • The ICT guided use of antibiotics in 30 cases and investigated infection in 10.
  • The bacteria detection rate was 88% (35/40 patients) in cases treated by the ICT.
  • Early assistance from the ICT is a key to preventing onset of MRSA infection.

Read the full abstract here

Screening test recommendations for methicillin-resistant Staphylococcus aureus surveillance practices

Whittington, M.D. et al. American Journal of Infection Control. Published online: 23 January 2017

Highlights: 

  • Rapid screening tests reduce unnecessary surveillance costs.
  • Using polymerase chain reaction with universal preemptive isolation minimizes total costs.
  • Using chromogenic agar 24-hour with targeted isolation minimizes total costs.
  • Although polymerase chain reaction minimized inappropriate costs, the added cost per test was only offset with universal preemptive isolation.

Read the full abstract here

Eight Years of Decreased MRSA Infections Associated With Veterans Affairs Prevention Initiative

Evans, M.E. et al. American Journal of Infection Control. 45(1) pp. 13-16

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Background: Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015.

Conclusions: MRSA HAI rates declined significantly in acute care, SCIUs, and LTCFs over 8 years of the Veterans Affairs MRSA Prevention Initiative.

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Reduction in hospital-associated MRSA with daily chlorhexidine gluconate bathing for medical inpatients

Lowe, C.F. et al. American Journal of Infection Control. Published online 8 December 2016

N0025608 TEM of vancomycin resistant enterococcus faecalis

Image source: J L Carson – Wellcome Images // CC BY-NC-ND 4.0

Image shows transmission electron microscopy of vancomycin resistant enterococcus faecalis.

Background: Daily bathing with chlorhexidine gluconate (CHG) is increasingly used in intensive care units to prevent hospital-associated infections, but limited evidence exists for noncritical care settings.

Conclusions: This prospective pragmatic study to assess daily bathing for CHG on inpatient medical units was effective in reducing hospital-associated MRSA and VRE. A critical component of CHG bathing on medical units is sustained and appropriate application, which can be a challenge to accurately assess and needs to be considered before systematic implementation.

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Reduction in methicillin-resistant Staphylococcus aureus colonisation: impact of a screening and decolonisation programme

Garvey, M.I. et al. Journal of Infection Prevention. Published online: 4 August 2016

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

Patients in care homes are often at ‘high risk’ of being methicillin-resistant Staphylococcus aureus (MRSA) colonised. Here we report the prevalence of MRSA, the effect of MRSA screening and decolonisation in Wolverhampton care-home residents.

Eighty-two care homes (1665 residents) were screened for MRSA, three times at 6-monthly intervals (referred to as phases one, two and three). Screening and decolonisation of MRSA-colonised residents led to a reduction in the prevalence of MRSA from 8.7% in phase one, 6.3% in phase 2 and 4.7% in phase three.

Overall, the study suggests that care-home facilities in Wolverhampton are a significant reservoir for MRSA; screening and decolonisation has reduced the risk to residents going for procedures and has indirectly impacted on MRSA rates in the acute Trust.

Read the abstract here

 

Staphylococcus aureus and surgical site infection. The benefit of screening and decolonization before surgery

Humphreys, H. et al. Journal of Hospital Infection. Published online: 18 June 2016

Image shows Staphylococcus aureus on ChromID CPS chromogenic agar. Isolate from a urine sample from a 45 year old catheterised male awaiting surgery for a bladder stone.

Surgical site infections (SSIs) are amongst the most common healthcare-associated infections and significantly contribute to patient morbidity and healthcare costs. Staphylococcus aureus is the most common microbial cause.

The epidemiology of S. aureus is changing, with the dissemination of newer clones and the emergence of mupirocin resistance. The prevention and control of SSIs is multi-modal and we have reviewed the evidence for the value of screening for nasal carriage of S. aureus and the subsequent decolonization of patients pre-operatively who are positive. Pre-operative screening, using culture- or molecular-based methods and the subsequent decolonization of patients positive for methicillin-susceptible S. aureus and methicillin resistant S. aureus (MRSA) reduces SSI and hospital stay. This applies especially to major clean surgery, such as cardiothoracic and orthopaedic, involving the insertion of implanted devices.

However, it requires a multi-disciplinary approach coupled with patient education. Universal decolonization pre-operatively without screening for S. aureus potentially compromises the capacity to monitor for the emergence of new clones of S. aureus, contributes to mupirocin resistance, and prevents the adjustment of surgical prophylaxis for MRSA, i.e. the replacement of a beta-lactam agent with a glycopeptides or alternative.

Read the abstract here