Reducing transmission of methicillin-resistant Staphylococcus aureus in a surgical ward of a resource-limited hospital in Indonesia: an intervention study

Abstract

SUMMARY Background Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in healthcare settings in Indonesia. Aim To evaluate the effect of a bundle of preventive measures on the transmission and acquisition of MRSA in a surgical ward of a resource-limited hospital in Indonesia. Methods The study consisted of a pre-intervention (7 months), intervention (2 months), and post-intervention phase (5 months) and included screening for MRSA among eligible patients, healthcare workers (HCWs), and the hospital environment. In the intervention phase, a bundle of preventive actions was introduced, comprising: a hand hygiene educational program, cohorting of MRSA-positive patients, decolonization therapy for all MRSA-positive patients and HCWs, and cleaning and disinfection of the ward's innate environment. Hand hygiene compliance was assessed throughout the study period. The primary outcome was the acquisition rate of MRSA among patients per 1,000 patient-days at risk. Clonality of MRSA isolates was determined by Raman spectroscopy and multilocus sequence typing. Findings In total, 1,120 patients were included. Hand hygiene compliance rate rose from 15% pre-intervention to 65% post-intervention ( P <0.001). The MRSA acquisition decreased from 9/1,000 patient-days at risk pre-intervention to 3/1,000 patient-days at risk post-intervention, but this difference did not reach statistical significance ( P =0.08). Raman type 9 which belonged to ST239 was the single dominant MRSA clone. Conclusion The introduction of a bundle of preventive measures may reduce MRSA transmission and acquisition among surgery patients in a resource-limited hospital in Indonesia, but additional efforts are needed.

Diversity and Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) Genotypes in Southeast Asia

“…Most of these MRSA cases showed resistance to beta-lactam antibiotics, but remained susceptible to non-beta-lactam groups. The endemicity of ST239-III continued to spread in Indonesia and was also reported subsequently in Malang (Dr. Saiful Anwar hospital) between 2012 and 2013 [126].…”

“…Another intriguing phenomenon was the continuous reporting of high-incidence PVLpositive methicillin-susceptible S. aureus (MSSA) in various Indonesian hospitals that were mostly resistant only to penicillin and tetracycline [124,127,128], which might have been a harbinger of PVL-positive MRSAs in the region. The emergence of CA-MRSA clones was observed through the reports of SCCmec type V in several locations: MRSA ST672-V in Semarang (Dr. Kariadi Hospital) [126] and ST772-V in Malang (Saiful Anwar Hospital) [127]. ST672-V exhibited resistance to fluoroquinolones, gentamicin, tetracycline, and trimethoprimsulfamethoxazole and does not express any PVL genes unlike ST772-V. Interestingly, the same clones were reported as emerging CA-MRSA clones in Indian hospitals [129].…”

Synthesis, Characterization, and Antibacterial Activity of Plant-Derived Zinc Oxide Nanostructure Using <i>Lavandula angustifolia</i> and <i>Phyllanthus niruri</i> Extracts

“…The chemical reaction for the formation of ZnO from the process of mixing Zn(CH 3 COOH) 2 •2H 2 O with NaOH is shown in Eq. (1)(2)(3)(4).…”

“…Some examples are methicillin-resistant Staphylococcus aureus (MRSA) and Klebsiella pneumonia infections in contaminated food and drinks. MRSA is a variant of the S. aureus bacteria, which has virulent characteristics, is resistant to many antibiotics, and often causes nosocomial infections in hospitalized patients [2]. K. pneumonia is the main bacteria that causes pneumonia, which is the largest cause of death among children [3].…”

Dangerous Pathogens as a Potential Problem for Public Health

“…Moreover, MRSA is one of the most common bacterial illnesses in hospitals. MRSA has been detected in the majority of countries around the world, but there are differences in scale of prevalence [91,92]. MRSA strains are divided into two types: community-acquired MRSA (CA-MRSA), isolated from outpatients, and hospital-acquired MRSA (HA-MRSA), isolated from hospitalized patients.…”