Significant reduction of endemic MRSA acquisition and infection in cardiothoracic patients by means of an enhanced targeted infection control programme

• Published in: The Journal of hospital infection Vol. 60; no. 2; pp. 104 - 110
• Main Authors: Schelenz, S., Tucker, D., Georgeu, C., Daly, S., Hill, M., Roxburgh, J., French, G.L.
• Format: Journal Article
• Language: English
• Published: Kent Elsevier Ltd 01.06.2005; Elsevier
• Subjects: Antibiotic Prophylaxis - methods; Bacteremia - epidemiology; Bacteremia - etiology; Bacteremia - prevention & control; Bacterial diseases; Biological and medical sciences; Cardiac surgery; Cardiac Surgical Procedures - adverse effects; Carrier State - prevention & control; Critical Pathways - organization & administration; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - prevention & control; Endemic Diseases - prevention & control; Endemic Diseases - statistics & numerical data; Epidemiology. Vaccinations; General aspects; Guideline Adherence - standards; Hand Disinfection; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infection Control - organization & administration; Infection control programme; Infectious diseases; London - epidemiology; Mass Screening - organization & administration; Medical sciences; Methicillin Resistance; MRSA; Patient Isolation; Practice Guidelines as Topic; Professional Staff Committees - organization & administration; Program Evaluation; Retrospective Studies; Risk Assessment; Risk Factors; Staphylococcal Infections - epidemiology; Staphylococcal Infections - etiology; Staphylococcal Infections - prevention & control; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; United Kingdom; Europe; London; United Kingdom > UK; England; Infection control programme; MRSA; Cardiac surgery; Nosocomial infection; Gentamicin; Health care staff; Check; Epidemiology; Teicoplanin; Incidence; Prevention; Surgery; Bacteria; Micrococcales; Micrococcaceae; Staphylococcus aureus; Human; Surgical wound; Health staff; Bacteremia; Infection; Antibiotic; Treatment; Aminoglycoside; Risk factor; Bacteriosis; Antibacterial agent; Staphylococcal infection; Colonization
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2004.11.020

Due to increasing methicillin-resistant Staphylococcus aureus (MRSA) infection in cardiothoracic patients at St Thomas' Hospital, an enhanced infection control programme was introduced in September 2000. It was based on UK national guidelines on the control of MRSA and targeted additional identified risk factors for surgical site infection (SSI). It included recognition of the problem by senior staff and their taking responsibility for it; intensive support, education and advice from the infection control team; improved ward and theatre hygiene; pre-admission, admission and weekly MRSA screening; isolation and clearance treatment; nursing care pathways for MRSA colonized patients; and teicoplanin plus gentamicin surgical prophylaxis. The effectiveness of the programme was assessed by retrospective analysis of computerized patient data for the 16 months before and after the introduction of the programme. There was no significant change in the number of operations or the proportion of patients admitted with MRSA, although nine patients were cleared of carriage before admission. However, there were significant falls in the proportion of patients acquiring MRSA on the ward [38/1036 to 14/921, P=0.003, RR 2.4 (95%CI 1.32–4.42)] and in the rate of bloodstream MRSA infections [12/1075 to 2/956, P=0.014, RR 5.34 (95%CI 1.20–23.78)]. Sternal and leg wound infections both halved (from 28/1075 to 13/956 and 16/1075 to 7/956, respectively) but this did not reach statistical significance. These results demonstrate that an enhanced, targeted infection control programme based on the UK national guidelines, SSI prevention guidelines and local risk assessment can reduce the incidence of nosocomial MRSA acquisition and invasive infection in cardiothoracic patients in the face of continuing endemic risk.