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Title: Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: A controlled multicentre intervention trial
Authors: Andie S. Lee
Ben S. Cooper
Surbhi Malhotra-Kumar
Annie Chalfine
George L. Daikos
Carolina Fankhauser
Biljana Carevic
Sebastian Lemmen
José Antonio Martinez
Cristina Masuet-Aumatell
Angelo Pan
Gabby Phillips
Bina Rubinovitch
Herman Goossens
Christian Brun-Buisson
Stephan Harbarth
Hopitaux universitaires de Geneve
Royal Prince Alfred Hospital
Mahidol University
Nuffield Department of Clinical Medicine
Universiteit Antwerpen
Groupe Hospitalier Paris Saint-Joseph
Laikon General Hospital
Department of Hospital Epidemiology
Medizinische Fakultat und Universitats Klinikum Aachen
Hospital Clinic Barcelona
Hospital Universitari de Bellvitge
Infectious and Tropical Diseases Unit
Ninewells Hospital
Rabin Medical Center Israel
Institut Pasteur, Paris
Universite Paris-Est
Keywords: Medicine
Issue Date: 16-Oct-2013
Citation: BMJ Open. Vol.3, No.9 (2013)
Abstract: Objective: To compare the effect of two strategies (enhanced hand hygiene vs meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonisation) alone and in combination on MRSA rates in surgical wards. Design: Prospective, controlled, interventional cohort study, with 6-month baseline, 12-month intervention and 6-month washout phases. Setting: 33 surgical wards of 10 hospitals in nine countries in Europe and Israel. Participants: All patients admitted to the enrolled wards for more than 24 h. Interventions: The two strategies compared were (1) enhanced hand hygiene promotion and (2) universal MRSA screening with contact precautions and decolonisation (intranasal mupirocin and Chlorhexidine bathing) of MRSA carriers. Four hospitals were assigned to each intervention and two hospitals combined both strategies, using targeted MRSA screening. Outcome measures: Monthly rates of MRSA clinical cultures per 100 susceptible patients (primary outcome) and MRSA infections per 100 admissions (secondary outcome). Planned subgroup analysis for clean surgery wards was performed. Results: After adjusting for clustering and potential confounders, neither strategy when used alone was associated with significant changes in MRSA rates. Combining both strategies was associated with a reduction in the rate of MRSA clinical cultures of 12% per month (adjusted incidence rate ratios (aIRR) 0.88, 95% CI 0.79 to 0.98). In clean surgery wards, strategy 2 (MRSA screening, contact precautions and decolonisation) was associated with decreasing rates of MRSA clinical cultures (15% monthly decrease, aIRR 0.85, 95% CI 0.74 to 0.97) and MRSA infections (17% monthly decrease, aIRR 0.83, 95% CI 0.69 to 0.99). Conclusions: In surgical wards with relatively low MRSA prevalence, a combination of enhanced standard and MRSA-specific infection control approaches was required to reduce MRSA rates. Implementation of single interventions was not effective, except in clean surgery wards where MRSA screening coupled with contact precautions and decolonisation was associated with significant reductions in MRSA clinical culture and infection rates.
ISSN: 20446055
Appears in Collections:Scopus 2011-2015

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