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An Integrated Approach to Methicillin-Resistant Staphylococcus aureus Control in a Rural, Regional-Referral Healthcare Setting

Published online by Cambridge University Press:  02 January 2015

William A. Bowler ,
Jeanine Bresnahan ,
Ann Bradfish  and
Christine Fernandez
William A. Bowler*
Affiliation:
Aspirus Wausau Hospital, Wausau, Wisconsin
Jeanine Bresnahan
Affiliation:
Aspirus Wausau Hospital, Wausau, Wisconsin
Ann Bradfish
Affiliation:
Aspirus Wausau Hospital, Wausau, Wisconsin
Christine Fernandez
Affiliation:
Aspirus Wausau Hospital, Wausau, Wisconsin
*
Aspirus Wausau Hospital, 333 Pine Ridge Blvd., Wausau, WI 54401 ([email protected])
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Extract

Objective.

To curtail the prevalence and cross-transmission of methicillin-resistant Staphylococcus aureus (MRSA) in a rural healthcare setting.

Design.

Before-after, quasi-experimental quality improvement study.

Setting.

A regional-referral hospital, 5 affiliated nursing homes, and an outpatient MRSA clinic.

Interventions.

Residents of the 5 nursing homes were screened for MRSA at baseline and 1 year later. Active surveillance cultures were performed on subsequently admitted nursing home residents, “high-risk” patients admitted to the hospital, and household contacts of clinic patients. The decolonization regimen consisted of systemic therapy with minocycline and rifampin and topical therapy with nasal mupirocin ointment and 5% tea tree oil body wash. Three separate samples for cultures to document clearance of MRSA colonization were obtained at 1-week intervals 1 month after the completion of decolonization therapy. Samples for follow-up cultures were obtained at month 6 and month 12 after the completion of decolonization therapy.

Results.

After intervention and follow-up for 12 months or more, the prevalence of MRSA carriage at the nursing homes decreased by 67% (P<.001), and 120 (82%) of 147 nursing home residents and 111 (89%) of 125 clinic patients remained culture-negative for MRSA. Twenty-three (24%) of 95 new clinic patients had at least 1 MRSA-positive contact. Mupirocin resistance did not develop. In the hospital, the incidence rate of nosocomial MRSA infection decreased from 0.64 infections per 1,000 patient-days before the interventions to 0.40 infections per 1,000 patient-days 1 year after the interventions and to 0.32 infections per 1,000 patient-days 2 years after the intervention (P<.01).

Conclusions.

Use of active surveillance cultures and decolonization therapy was effective in decreasing the prevalence of asymptomatic carriage, the incidence of nosocomial infection, and the overall prevalence of MRSA in our rural healthcare setting.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 3 , March 2010 , pp. 269 - 275
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by mefhicillin-resistant Staphylococcus aureus, United States, 1999–2005. Emerg Infect Dis 2007;13(12):1840–1846.Google Scholar
2.Davis, KA, Stewart, JJ, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004;39:776–782.Google Scholar
3.Williams, VR, Callery, S, Vearncombe, M, Simor, AE. The role of colonization pressure in nosocomial transmission of mefhicillin-resistant Staphylococcus aureus. Am J Infect Control 2009;37:106–110.Google Scholar
4.Safdar, N, Bradley, EA. The risk of infection after nasal colonization with Staphylococcal aureus. Am J Med 2008;121:310–315.Google Scholar
5.Huang, SS, Piatt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.Google Scholar
6.Huang, SS, Hinrichsen, VL, Stuglis, L, et al.Methicillin-resistant Staphylococcus aureus infection in the year following detection of carriage. In: Program and abstracts of the 16th Annual Scientific Meeting of the Society of Healthcare Epidemiology; March 18–21, 2006; Chicago, IL. Abstract 157.Google Scholar
7.Datta, R, Huang, SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis 2008;47:176–181.Google Scholar
8.Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
9.Kirkland, KB, Weinstein, JB. Adverse effects of contact isolation. Lancet 1999;354:1177–1178.CrossRefGoogle ScholarPubMed
10.Evans, HL, Shaffer, MM, Hughes, MG, et al.Contact isolation in surgical patients: a barrier to care? Surgery 2003;134:180–188.CrossRefGoogle ScholarPubMed
11.Carson, CF, Cookson, BD, Farrelly, HD, Riley, TV. Susceptibility of methicillin-resistant Staphylococcus aureus to the essential oil of Malaleuca alternifolia. J Antimicrob Chemother 1995;35:421–424.Google Scholar
12.May, J, Chan, CH, King, A, Williams, L, French, GL. Time-kill studies of tea tree oils on clinical isolates. J Antimicrob Chemother 2000;45:639–643.Google Scholar
13.Carson, CF, Mee, BJ, Riley, TV. Mechanism of action of Malaleuca alternifolia (tea tree oil) on Staphylococcus aureus determined by time-kill, lysis, leakage, and salt tolerance assays and electron microscopy. Antimicrob Agents Chemother 2002;46:1914–1920.CrossRefGoogle Scholar
14.Dryden, MS, Dailly, S, Crouch, M. A randomized, controlled trial of tea tree topical preparations versus a standard topical regimen for the clearance of MRSA colonization. J Hosp Infect 2004;56:283–286.Google Scholar
15.Borlaug, G, Davis, JP, Fox, BC. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA): guidelines for clinical management and control of transmission. Wisconsin Division of Public Health. PPH 42160. October 2005.Google Scholar
16.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
17.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
18.Kotilainen, P, Routamaa, M, Peltonen, R, et al.Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 2003;9:169–175.Google Scholar
19.van Trijp, MJ, Melles, DC, Hendriks, WD, Parlevliet, GA, Gommans, A, Ott, A. Successful control of widespread methicillin-resistant Staphylococcus aureus colonization and infection in a large teaching hospital in the Netherlands. Infect Control Hosp Epidemiol 2007;28:970–975.Google Scholar
20.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
21.Loeb, M, Main, C, Walker-Dilks, C, Eady, A. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Data-base Syst Rev 2003;4:CD003340.Google Scholar
22.Simor, AE, Phillips, E, McGeer, A, et al.Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis 2007;44:178–185.Google Scholar
23.Ridenour, G, Lampen, R, Federspiel, J, Kritchevsky, S, Wong, E, Climo, M. Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007;28:1155–1161.Google Scholar
24.Kotilainen, P, Routamaa, M, Peltonen, R, et al.Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001;161:859–863.Google Scholar
25.Harberg, D. SHEA guideline approach works to control a methicillin-resistant Staphylococcus aureus outbreak. Infect Control Hosp Epidemiol 2005;26:115–116.Google Scholar
26.Miller, LG, Diep, BA. Colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008;46:752–760.Google Scholar
27.Calfee, DP, Durbin, LJ, Germanson, TP, Toney, DM, Smith, EB, Farr, BM. Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA. Infect Control Hosp Epidemiol 2003;24:422–426.Google Scholar
28.Johansson, PJH, Gustafsson, EB, Ringberg, H. High prevalence of MRSA in household contacts. Scand J Infect Dis 2007;39:764–768.Google Scholar
29.Hota, B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39:1182–1189.Google Scholar
30.Mertz, D, Frei, R, Jaussi, B. Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus. Clin Infect Dis 2007;45:475–477.CrossRefGoogle ScholarPubMed
31.Nilsson, P, Torvald, R. Staphylococcus aureus throat colonization is more frequent than colonization in the anterior nares. J Clin Microbiol 2006;44:3334–3339.Google Scholar
32.Mody, L, Kauffman, CA, Donabedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46:1368–1373.Google Scholar