Control of Epidemic Methicillin-Resistant Staphylococcus aureus

Abstract

We controlled the spread of epidemic methicillin-resistant Staphylococcus aureus (MRSA) infection in an 884-bed veterans' facility by cohorting known active MRSA carriers and MRSA-infected patients on one nursing unit. Simultaneously, all previously-institutionalized transfers into the veterans' facility were screened with swab cultures for MRSA at the time of admission. All MRSA patients were maintained on contact (gown and glove) or strict isolation and treated aggressively with topical and enteral antibiotics with the assistance of the infectious disease consultant. The monthly incidence of new MRSA patients dropped from a maximum of 16 per month to three or less per month within six months of instituting these infection control measures. There were no further MRSA bacteremias after the establishment of the MRSA cohort in a single unit. Aggressive cohort management of known MRSA patients and screening of previously-institutionalized patients on admission for MRSA controlled epidemic MRSA in this large institution.

Molecular Epidemiology of Methicillin-Resistant Staphyloccocus aureus at a Low-Incidence Hospital over a 4-Year Period

“…2g v 30 In other studies, only the combination of isolation, extended screening, and mupirocin treatment of carriers 3 1 or systemic treatment 32 * 33 was able to contain epidemics. In a long-term prospective study, combined measures were able to terminate several epidemics, to control undetected clusters, and to limit nosocomial transmission.…”

Quarantine, Isolation, and Cohorting: From Cholera toKlebsiella

“…Spread can occur from a healthcare worker to patients, such as an epidemic of Pseudomonas aeruginosa among neonates cared for by the same nurse during intermittent otitis externa infections, proving ''we are the fomites of disease-the vectors of transmission of nosocomial pathogens'' [48,49]. Direct transmission also occurs with widespread movement of patients and staff between wards, overcrowding, close proximity of patients, and larger numbers of patients per room, such as when four patients are housed together, as was seen in two MRSA outbreaks [15,22]. Numerous studies have determined the clonal relatedness of isolated pathogens by pulsed-field gel electrophoresis (PFGE).…”

“…Doctor Barrett predicted that ''methicillin-resistant staphylococci will become more widespread in the United States and may present some clinical and epidemiologic problems in the future'' [19]. This forecast was correct: The following four decades were replete with instances of MRSA outbreaks in the community, hospital wards, nursing facilities, and, ubiquitously, medical, surgical, and neonatal intensive care units (ICUs) [15,[20][21][22][23][24][25][26][27]. The 1980s saw the arrival of MDROs expressing resistance to progressively newer antibiotics.…”

“…This has proved effective for disrupting outbreaks of MRSA [21,22,26,27], VRE [38,39,[41][42][43], ESBL-producing K. pneumoniae [30,[32][33][34], S. marcescens [44], Acinetobacter baumannii [31,[45][46][47], and P. aeruginosa [48].…”

“…In 1973, a 1,000-bed hospital converted a standard ward into an isolation unit, complete with individual washroom facilities and a central exhaust system to control ventilation [21]. Ten years later, a large Veterans Affairs medical center controlled a large MRSA outbreak with an isolated ward staffed with a dedicated medical team [22]. This same single-unit isolation cohorting has been successful in other settings, including outbreaks of neonatal ICU-acquired A. baumannii with the establishment of a separate cohort nursery; VRE by implementing a hospital ward capable of providing various levels of care, including intensive care to rehabilitation for infected patients; and finally for carbapenem-resistant K. pneumoniae by cohorting patients infected or colonized into a single unit with a dedicated nursing staff [34,41,47].…”