Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore

Fisher, Dale; Tambyah, Paul Ananth; Lin, Raymond T. P.; Jureen, Roland; Cook, Alex R.; Lim, Amanda Yuan Ling; Ong, Benjamin; Balm, Michelle; Ng, Tat Ming; Hsu, Li Yang

doi:10.1016/j.jhin.2013.07.005

Cited by 18 publications

(24 citation statements)

References 21 publications

(17 reference statements)

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“…Evaluation of the evidence from 13 studies (11 noncontrolled before-after [39][40][41][42][43][44][45][46][47][48][49], one interrupted time series [50] and one qualitative study [51]) showed that a hospital-based surveillance system, especially when linked to national surveillance networks, is associated with a decrease in overall HAI, central line-associated bloodstream infections, ventilator-associated pneumonia, surgical site infection, and catheter-related urinary tract infections. The studies also emphasized that the timely feedback of results is influential in the implementation of effective IPC actions.…”

Section: (Strong Recommendation Very Low Quality Of Evidence)mentioning

confidence: 99%

“…The studies also emphasized that the timely feedback of results is influential in the implementation of effective IPC actions. Active surveillance with public feedback as part of a methicillin-resistant Staphylococcus aureus (MRSA) care bundle strategy was associated with a decrease in MRSA infections in a hospital in Singapore [50]. One qualitative study explored the importance of surveillance and feedback to stakeholders and found that they were very influential in the implementation of an IPC programme targeting ventilator-associated pneumonia [51].…”

Section: (Strong Recommendation Very Low Quality Of Evidence)mentioning

confidence: 99%

“…Evaluation of the evidence from 44 studies (13 noncontrolled before-after [22,37,[54][55][56][57][58][59][60][61][62][63][64], eight noncontrolled cohort trials [65][66][67][68][69][70][71][72], ten interrupted time series [18,25,27,29,50,[73][74][75][76][77], four qualitative [31,[78][79][80], three randomized controlled trials [81][82][83], two controlled before-after [35,84], two mixed methods [38,85], one non-controlled interrupted time series [86] and one stepped wedge [87]) showed that implementing IPC activities at facility level using multimodal strategies is effective to improve IPC practices and reduce HAI. This was particularly relevant for hand hygiene compliance, central line-associated bloodstream infection, ventilatorassociated pneumonia and infections caused by MRSA and Clostridium difficile.…”

Section: (Strong Recommendation Low Quality Of Evidence)mentioning

confidence: 99%

“…Multimodal strategies included the following components: system change; education; awareness raising; bundle-based strategies; promotion of a patient safety culture, including leadership engagement, identification of champions and positive reinforcement strategies; and increased accountability via monitoring and timely feedback. Forty studies were from high-income countries [18,25,27,31,37,38,50,[54][55][56][57][58][59][60], two from one upper-middle-income country [29,35], and one from a Lower-Middle-Income Country [61].…”

Section: (Strong Recommendation Low Quality Of Evidence)mentioning

confidence: 99%

See 3 more Smart Citations

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Storr

Twyman

Zingg

et al. 2017

Antimicrob Resist Infect Control

357

306

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Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0149-9) contains supplementary material, which is available to authorized users.

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Section: (Strong Recommendation Very Low Quality Of Evidence)mentioning

confidence: 99%

Section: (Strong Recommendation Very Low Quality Of Evidence)mentioning

confidence: 99%

Section: (Strong Recommendation Low Quality Of Evidence)mentioning

confidence: 99%

Section: (Strong Recommendation Low Quality Of Evidence)mentioning

confidence: 99%

See 2 more Smart Citations

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Storr

Twyman

Zingg

et al. 2017

Antimicrob Resist Infect Control

357

306

View full text Add to dashboard Cite

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“…Remarkably, a decreasing trend in MRSA bacteremia has been seen since 2006 in UK, following a government initiative to establish a mandatory surveillance and a target to reduce MRSA bacteremia rates over a 3-year period [5], facilitated by the corresponding optimization of administrative support, infrastructural change and resource allocation [1].…”

Section: Introductionmentioning

confidence: 99%

Minimal Intervention for Controlling Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus in Resource Limited Setting with High Endemicity

et al. 2014

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ObjectiveTo control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in resource-limited healthcare setting with high endemicity.MethodsThree phases of infection control interventions were implemented in a University-affiliated hospital between 1-January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per-1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model). Usage density of broad-spectrum antibiotics was monitored.ResultsDuring the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3%) were hospital-acquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001), 30.4% (p<0.001), and 19.6% (p = 0.040), while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001), 24.1% (p<0.001), and 21.9% (p = 0.041) respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1) to 168.99 per 1000 patient-days (phase 3).ConclusionsNosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing for MRSA-positive despite an increasing consumption of broad-spectrum antibiotics.

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Interventions to improve hand hygiene compliance in patient care

Gould

Moralejo

Drey

et al. 2017

Cochrane Database of Systematic Reviews

320

170

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Background Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an e ective preventive measure. This is an update of a previously published review. Objectives To assess the short-and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection.

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Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore

Abstract: Successful staged implementation of an MRSA bundle in a hyper-endemic setting is sustainable and represents a model that may be adapted for similar settings.

Cited by 18 publications

References 21 publications

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Minimal Intervention for Controlling Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus in Resource Limited Setting with High Endemicity

Interventions to improve hand hygiene compliance in patient care

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