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Infectious diseases
Research
Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
  1. Andie S Lee1,2,
  2. Ben S Cooper3,4,
  3. Surbhi Malhotra-Kumar5,
  4. Annie Chalfine6,
  5. George L Daikos7,
  6. Carolina Fankhauser1,
  7. Biljana Carevic8,
  8. Sebastian Lemmen9,
  9. José Antonio Martínez10,
  10. Cristina Masuet-Aumatell11,
  11. Angelo Pan12,
  12. Gabby Phillips13,
  13. Bina Rubinovitch14,
  14. Herman Goossens5,
  15. Christian Brun-Buisson15,
  16. Stephan Harbarth1,
  17. for the MOSAR WP4 Study Group
  1. 1Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
  2. 2Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
  3. 3Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
  4. 4Nuffield Department of Clinical Medicine, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
  5. 5Department of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
  6. 6Infection Control Unit, Groupe Hospitalier Paris Saint-Joseph, Paris, France
  7. 7First Department of Propaedeutic Medicine, Laiko General Hospital, Athens, Greece
  8. 8Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade, Serbia
  9. 9Department of Infection Control and Infectious Diseases, Universitätsklinikum Aachen, Aachen, Germany
  10. 10Service of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
  11. 11Preventive Medicine Department and Faculty of Medicine, Bellvitge Biomedical Research Institute (IDIBELL), University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
  12. 12Infectious and Tropical Diseases Unit, Istituti Ospitalieri di Cremona, Cremona, Italy
  13. 13Infection Control Department, Ninewells Hospital, Dundee, Scotland
  14. 14Unit of Infection Control, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
  15. 15Inserm U 657, Institut Pasteur, Paris; Department of Intensive Care, Hopital Henri Mondor, Universite Paris-Est Creteil, Creteil, France
  1. Correspondence to Dr Stephan Harbarth; stephan.harbarth{at}hcuge.ch

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.

Trial registration clinicaltrials.gov identifier: NCT00685867

  • Infection Control < Infectious Diseases
  • Surgery

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-003126

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