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The Effect of Universal Decolonization With Screening in Critical Care to Reduce MRSA Across an Entire Hospital

Published online by Cambridge University Press:  06 February 2017

Craig W. Bradley ,
Martyn A. C. Wilkinson  and
Mark I. Garvey
Craig W. Bradley
Affiliation:
University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
Martyn A. C. Wilkinson
Affiliation:
University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
Mark I. Garvey*
Affiliation:
University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
*
Address correspondence to Mark Garvey, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB United Kingdom ([email protected]).
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Abstract

OBJECTIVE

To describe the effect of universal methicillin-resistant Staphylococcus aureus (MRSA) decolonization therapy in a large intensive care unit (ICU) on the rates of MRSA cases and acquisitions in a UK hospital.

DESIGN

Descriptive study.

SETTING

University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, United Kingdom, that provides clinical services to nearly 1 million patients every year.

METHODS

A break-point time series analysis and kernel regression models were used to detect significant changes in the cumulative monthly numbers of MRSA bacteremia cases and acquisitions from April 2013 to August 2016 across the UHB system.

RESULTS

Prior to 2014, all ICU patients at UHB received universal MRSA decolonization therapy. In August 2014, UHB discontinued the use of universal decolonization due to published reports in the United Kingdom detailing the limited usefulness and cost-effectiveness of such an intervention. Break-point time series analysis of MRSA acquisition and bacteremia data indicated that break points were associated with the discontinuation and subsequent reintroduction of universal decolonization. Kernel regression models indicated a significant increase (P<.001) in MRSA acquisitions and bacteremia cases across UHB during the period without universal decolonization.

CONCLUSION

We suggest that routine decolonization for MRSA in a large ICU setting is an effective strategy to reduce the spread and incidence of MRSA across the whole hospital.

Infect Control Hosp Epidemiol 2017;38:430–435

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 4 , April 2017 , pp. 430 - 435
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Garvey, MI, Winfield, J, Wiley, C, Reid, M, Cooper, M. Reduction in methicillin-resistant Staphylococcus aureus colonisation: impact of a screening and decolonisation programme. J Infect Prev 2016 (in press).CrossRefGoogle Scholar
2. Simor, AE. Staphylococcal decolonization: an effective strategy for prevention of infection? Lancet Infect Dis 2011;11:952–962.CrossRefGoogle Scholar
3. Simor, AE, Loeb, M. Epidemiology of healthcare-associated Staphylococcus aureus infections. In: Crossley KB, Jefferson KK, Archer G, Fowler VG Jr, eds. Staphylococci in Human Disease, 2nd ed. Oxford: Blackwell Publishing; 2009. Pp. 290–309.CrossRefGoogle Scholar
4. Robotham, JV, Graves, N, Cookson, BD, et al. Screening, isolation, and decolonization strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation. BMJ 2011;5(343):d5694.CrossRefGoogle Scholar
5. Baldwin, NS, Gilpin, DF, Tunney, MM, et al. Cluster randomised controlled trial of an infection control education and training intervention programme focusing on methicillin-resistant Staphylococcus aureus in nursing homes for older people. J Hosp Infect 2010;76:36–41.CrossRefGoogle ScholarPubMed
6. Robicsek, A, Beaumont, JL, Thomson, RB Jr, Govindarajan, G, Peterson, LR. Topical therapy for meticillin-resistant Staphylococcus aureus colonization: impact on infection risk. Infect Control Hosp Epidemiol 2009;30:623–632.CrossRefGoogle Scholar
7. Bode, LG, Kluytmans, JA, Wertheim, HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus . N Engl J Med 2010;362:9–17.CrossRefGoogle ScholarPubMed
8. Cepeda, JA, Whitehouse, T, Cooper, B, et al. Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 2005;365:295–304.CrossRefGoogle ScholarPubMed
9. Robotham, JV, Deeny, SR, Fuller, C, Hopkins, S, Cookson, B, Stone, S. Cost-effectiveness of national mandatory screening of all admissions to English National Health Service hospitals for meticillin-resistant Staphylococcus aureus: a mathematical modelling study. Lancet Infect Dis 2016;16:348–356.CrossRefGoogle ScholarPubMed
10. Coia, JE, Duckworth, GJ, Edwards, DI, et al. Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection Society; Infection Control Nurses Association. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63:S1–S44.CrossRefGoogle ScholarPubMed
11. Leonhardt, K, Yakusheva, O, Phelan, D, et al. Clinical effectiveness and cost benefit of universal versus targeted meticillin-resistant Staphylococcus aureus screening upon admission in hospitals. Infect Control Hosp Epidemiol 2011;32:797–803.CrossRefGoogle Scholar
12. Gidengil, CA, Gay, C, Huang, SS, Platt, R, Yokoe, D, Lee, GM. Cost effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit. Infect Control and Hosp Epidemiol 2015;36:797–803.CrossRefGoogle Scholar
13. Ziakas, PD, Zacharioudakis, IM, Zervou, FN, Mylonakis, E. Meticillin-resistant Staphylococcus aureus prevention strategies in the ICU: a clinical analysis. Crit Care Med 2015;43:392–393.CrossRefGoogle Scholar
14. Fuller, C, Robotham, J, Savage, J, et al. The national one-week prevalence audit of universal meticillin-resistant Staphylococcus aureus (MRSA) admission screening 2012. PLoS one 2013;12:e74219.CrossRefGoogle Scholar
15. Garvey, MI, Pichon, B, Bradley, CW, Moiemen, NS, Oppenheim, B, Kearns, AM. Improved understanding of an outbreak of methicillin resistant Staphylococcus aureus in a regional burns centre via whole-genome sequencing. J Hosp Infect 2016;94:401–404.CrossRefGoogle Scholar
16. Guidance on the reporting and monitoring arrangements and post infection review process for MRSA bloodstream infections from April 2014. Patient Safety Domain, NHS England website. https://www.england.nhs.uk/patientsafety/wp-content/uploads/sites/32/2014/02/post-inf-guidance2.pdf. Published 2014. Accessed January 5, 2017.Google Scholar
17. Hughes, GJ, Nickerson, E, Enoch, DA, et al. Impact of cleaning and other interventions on the reduction of hospital acquired Clostridium difficile infections in two hospitals in England assesses using a breakpoint model. J Hosp Infect 2013;84:227–234.CrossRefGoogle ScholarPubMed
18. R version 3.3.1 (2016-06-21)—“Bug in Your Hair.” The R Foundation for Statistical Computing website. https://www.r-project.org/. Published 2016. Accessed January 5, 2017.Google Scholar
19. Huang, S, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:2255–2265.CrossRefGoogle ScholarPubMed
20. Dodémont, M, Verhulst, C, Nonhoff, C, Nagant, C, Denis, O, Kluytmans, J. Prospective two-centre comparison of three chromogenic agars for meticillin-resistant Staphylococcus aureus screening in hospitalized patients. J Clin Microbiol 2015;53:3014–3016.CrossRefGoogle Scholar