Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-25T18:38:04.088Z Has data issue: false hasContentIssue false
  • English
  • Français

A Retrospective Cohort Study into Acquisition of MRSA and Associated Risk Factors after Implementation of Universal Screening in Scottish Hospitals

Published online by Cambridge University Press:  02 January 2015

E. V. H. van Velzen ,
J. S. Reilly ,
K. Kavanagh ,
A. Leanord ,
G. F. S. Edwards ,
E. K. Girvan ,
I. M. Gould ,
F. M. MacKenzie  and
R. Masterton
E. V. H. van Velzen*
Affiliation:
Health Protection Scotland, Glasgow, United Kingdom European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
J. S. Reilly
Affiliation:
Health Protection Scotland, Glasgow, United Kingdom
K. Kavanagh
Affiliation:
University of Strathclyde, Glasgow, United Kingdom
A. Leanord
Affiliation:
National Health Service (NHS) Greater Glasgow and Clyde, Glasgow, United Kingdom
G. F. S. Edwards
Affiliation:
Scottish MRSA Reference Laboratory, Glasgow, United Kingdom
E. K. Girvan
Affiliation:
Scottish MRSA Reference Laboratory, Glasgow, United Kingdom
I. M. Gould
Affiliation:
NHS Grampian Health Board, Aberdeen, United Kingdom
F. M. MacKenzie
Affiliation:
NHS Grampian Health Board, Aberdeen, United Kingdom
R. Masterton
Affiliation:
NHS Ayrshire and Arran Health Board, Ayrshire, United Kingdom
*
Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, United Kingdom ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To estimate the proportion of patients who acquire methicillin-resistant Staphylococcus aureus (MRSA) while in hospital and to identify risk factors associated with acquisition of MRSA.

Design.

Retrospective cohort study.

Patients.

Adult patients discharged from 36 general specialty wards of 2 Scottish hospitals that had implemented universal screening for MRSA on admission.

Methods.

Patients were screened for MRSA on discharge from hospital by using multisite body swabs that were tested by culture. Discharge screening results were linked to admission screening results. Genotyping was undertaken to identify newly acquired MRSA in MRSA-positive patients on admission.

Results.

Of the 5,155 patients screened for MRSA on discharge, 2.9% (95% confidence interval [CI], 2.43–3.34) were found to be positive. In the subcohort screened on both admission and discharge (n = 2,724), 1.3% of all patients acquired MRSA while in hospital (incidence rate, 2.1/1,000 hospital bed-days in this cohort [95% CI, 1.5–2.9]), while 1.3% remained MRSA positive throughout hospital stay. Three risk factors for acquisition of MRSA were identified: age above 64 years, self-reported renal failure, and self-reported presence of open wounds. On a population level, the prevalence of MRSA colonization did not differ between admission and discharge.

Conclusions.

Cross-transmission of MRSA takes place in Scottish hospitals that have implemented universal screening for MRSA. This study reinforces the importance of infection prevention and control measures to prevent MRSA cross-transmission in hospitals; universal screening for MRSA on admission will in itself not be sufficient to reduce the number of MRSA colonizations and subsequent MRSA infections.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 9 , September 2011 , pp. 889 - 896
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Boyce, JM, Cookson, B, Christiansen, K, et al.Meticillin-resistant Staphylococcus aureus. Lancet Infect Dis 2005;5:653–663.CrossRefGoogle ScholarPubMed
2.Reilly, J, Stewart, S, Allardice, G, et al.NHS Scotland national HAI prevalence survey: final report. Glasgow: Health Protection Scotland, 2007.Google Scholar
3.Health Protection Scotland. The annual surveillance of healthcare associated infections report January-December 2009. Glasgow: Health Protection Scotland, 2010.Google Scholar
4.Gopal Rao, G, Michalczyk, P, Nayeem, N, Walker, G, Wigmore, L. Prevalence and risk factors for meticillin-resistant Staphylococcus aureus in adult emergency admissions: a case for screening all patients? J Hosp Infect 2007;66:15–21.CrossRefGoogle ScholarPubMed
5.Peterson, LR, Diekema, DJ. To screen or not to screen for methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2010;48:683–689.CrossRefGoogle ScholarPubMed
6.Reilly, JS, Stewart, S, Christie, P, et al.Universal screening for meticillin-resistant Staphylococcus aureus: interim results from the NHS Scotland pathfinder project. J Hosp Infect 2010;74:35–41.CrossRefGoogle ScholarPubMed
7.Health Protection Scotland on behalf of Pathfinder Health Boards. Final report volume 1: an investigation of the clinical effectiveness of MRSA screening. Glasgow: Health Protection Scotland, 2009.Google Scholar
8.Wertheim, HF, Melles, DC, Vos, MC, et al.The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751–762.CrossRefGoogle ScholarPubMed
9.Harbarth, S, Fankhauser, C, Schrenzel, J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149–1157.CrossRefGoogle ScholarPubMed
10.Fishbain, JT, Lee, JC, Nguyen, HD, et al.Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates. Infect Control Hosp Epidemiol 2003;24:415–421.CrossRefGoogle ScholarPubMed
11.Jeyaratnam, D, Whitty, CJ, Phillips, K, et al.Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial. BMJ 2008;336:927–930.CrossRefGoogle ScholarPubMed
12.Rioux, C, Armand-Lefevre, L, Guerinot, W, Andremont, A, Lucet, JC. Acquisition of methicillin-resistant Staphylococcus aureus in the acute care setting: incidence and risk factors. Infect Control Hosp Epidemiol 2007;28:733–736.CrossRefGoogle ScholarPubMed
13.Health Protection Scotland. The value of nasal swabbing versus full body screening or clinical risk assessment to detect MRSA colonisation at admission to hospital. Glasgow: Health Protection Scotland, 2010.Google Scholar
14.Ritchie, K, Craig, J, Eastgate, J, et al.The clinical and cost effectiveness of screening for meticillin-resistant Staphylococcus aureus (MRSA). Edinburgh: NHS Quality Improvement Scotland, 2007.Google Scholar
15.Coia, JE, Duckworth, GJ, Edwards, DI, et al.Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63(suppl):S1–S44.CrossRefGoogle ScholarPubMed
16.Health Protection Scotland on behalf of Pathfinder Health Boards. Final report volume 4: to evaluate the feasibility and potential for rollout of the MRSA screening programme. Glasgow: Health Protection Scotland, 2009.Google Scholar
17.Bignardi, GE, Woodford, N, Chapman, A, Johnson, AP, Speller, DC. Detection of the mec-A gene and phenotypic detection of resistance in Staphylococcus aureus isolates with borderline or low-level methicillin resistance. J Antimicrob Chemother 1996;37:53–63.CrossRefGoogle ScholarPubMed
18.Brakstad, OG, Aasbakk, K, Maeland, JA. Detection of Staphylococcus aureus by polymerase chain reaction amplification of the nuc gene. J Clin Microbiol 1992;30:1654–1660.CrossRefGoogle ScholarPubMed
19.Bannerman, TL, Hancock, GA, Tenover, FC, Miller, JM. Pulsed-field gel electrophoresis as a replacement for bacteriophage typing of Staphylococcus aureus. J Clin Microbiol 1995;33:551–555.CrossRefGoogle ScholarPubMed
20.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
21.Holmes, A, Edwards, GF, Girvan, EK, et al.Comparison of two multilocus variable-number tandem-repeat methods and pulsed-field gel electrophoresis for differentiating highly clonal methicillin-resistant Staphylococcus aureus isolates. J Clin Microbiol 2010;48:3600–3607.CrossRefGoogle ScholarPubMed
22.Juul, S. An introduction to Stata for health researchers. 2nd ed. College Station, TX: Stata, 2008.Google Scholar
23.Bland, M. An introduction to medical statistics. 2nd ed. New York: Oxford University Press, 1995.Google Scholar
24.Rivero-Perez, B, Perez-Roth, E, Mendez-Alvarez, S. Evaluation of multiple-locus variable-number tandem-repeat analysis for typing a polyclonal hospital-acquired methicillin-resistant Staphylococcus aureus population in an area where such infections are endemic. J Clin Microbiol 2010;48:2991–2994.CrossRefGoogle Scholar
25.Scriven, JM, Silva, P, Swann, RA, et al.The acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in vascular patients. Eur J Vase Endovasc Surg 2003;25:147–151.CrossRefGoogle ScholarPubMed
26.Warren, DK, Guth, RM, Coopersmith, CM, Merz, LR, Zack, JE, Fraser, VJ. Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol 2006;27:1032–1040.CrossRefGoogle Scholar