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

https://www.flickr.com/photos/wellcomeimages/16003100451/in/photolist-qo95e2-fCw4hb-53wmHs-58CKUe-cw4Wfq-cw4UMo-cw4WL3-cw4VJU-7ojVRv-4CaQEw-4C6xeT-EU6nC-4CaQLJ-q6Lo13-qoj7iX-4CaQDu-EU4Nk-zpiJyu-4CaQMY-qm32Db-j4vREz-or2Sbx-oHuHUf-j4MspC-9y4sDM-or32x7-dQjFSx-a4RLq5-6JBQwo-bpzxT4-iQPVjT-oHuBLJ-or2TEV-oY1BkX-bpCfQR-fN98g7-4CaQCA-4C6xnp-4C6xoc-4C6xmt-4C6xji-fzTQ3p-9RQsFL-7uoVdt-4bAWxg-oHfG5k-DEvM97-9y7kCs-9TwwGL-9TwvXh
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.

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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

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Image source: Nathan Reading // CC BY-NC-ND 2.0

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.

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What should we do NOW? Review of a large NHS Trust’s meticillin-resistant Staphylococcus aureus screening

Smith, S.J. et al.Journal of Hospital Infection. Published online: 13 May 2016

Universal meticillin-resistant Staphylococcus aureus (MRSA) screening has been in effect since 2010. MRSA bacteraemia rates have declined substantially, with continuing low MRSA prevalence in hospitals.1 In 2013, the UK Department of Health (DH) commissioned a review of MRSA screening ‒ The National One Week prevalence audit (NOW) ‒ which reviewed the cost-effectiveness of a variety of screening strategies.2Modelling studies determined that the current practice of universal MRSA screening was the least cost-effective and that current compliance with screening was low at 65.7%.

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Methicillin-resistant Staphylococcus aureus in palliative care

Schmalz, O. et al. Palliative Medicine. Published online: 29 April 2016.

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Image source: Milos Kalab – Wellcome Images // CC BY-NC-ND 4.0

Image shows enhanced scanning electron micrograph of Staphylococcus aureus

Background: Methicillin-resistant Staphylococcus aureus is a common organism in hospitals worldwide and is associated with morbidity and mortality. However, little is known about the prevalence in palliative care patients. Furthermore, there is no standardized screening protocol or treatment for patients for whom therapy concentrates on symptom control.

Aim: Examining the prevalence of methicillin-resistant Staphylococcus aureus in palliative care patients as well as the level of morbidity and mortality.

Design: We performed a prospective study where methicillin-resistant Staphylococcus aureus screening was undertaken in 296 consecutive patients within 48 h after admission to our palliative care unit. Medical history was taken, clinical examination was performed, and the Karnofsky Performance Scale and Palliative Prognostic Score were determined. Prevalence of Methicillin-resistant Staphylococcus aureus was compared to data of general hospital patients.

Results: In total, 281 patients were included in the study having a mean age of 69.7 years (standard deviation = 12.9 years) and an average Karnofsky Performance Scale between 30% and 40%. The mean length of stay was 9.7 days (standard deviation = 7.6 days). A total of 24 patients were methicillin-resistant Staphylococcus aureus positive on the first swab. Median number of swabs was 2. All patients with a negative methicillin-resistant Staphylococcus aureus swab upon admission remained Methicillin-resistant Staphylococcus aureus negative in all subsequent swabs.

Conclusion: Our study suggests that the prevalence of Methicillin-resistantS taphylococcus aureus among patients in an in-hospital palliative care unit is much higher than in other patient populations.

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Facial hair – what about clinical microbiology technicians?

Lindeholm, Y.N. & Arpi, M. Journal of Hospital Infection. Published online: 22 April 2016

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Image source: Aaron Morton // CC BY-NC-ND 2.0

In 2014 Wakeam et al. in this journal published their results from a cross-sectional study which compared facial bacterial colonization rates of potential nosocomial significance among 408 male healthcare workers with and without facial hair.1 All participants in this study had routine direct patient contact. They found that workers with facial hair were significantly less likely to be colonized with Staphylococcus aureus, including meticillin-resistant S. aureus, and meticillin-resistant coagulase-negative staphylococci.

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