Conventional Infection-Control Measures Reduce MRSA

A hospital-based strategy using multiple infection-control interventions resulted in more than a 90% reduction in health care–associated infections due to methicillin-resistant Staphylococcus aureus without the need for active MRSA surveillance.

Findings from a 7-year observational study add support to the argument that the controversial practice of active surveillance is excessively resource-intensive and of limited value because it targets only MRSA and not other common nosocomial pathogens, Dr. Michael Edmond said in a telebriefing held in advance of the Decennial International Conference on Healthcare-Associated Infections.

Other disadvantages and unintended consequences of so-called “active detection and isolation” (ADI) include high cost, ethical issues, increases in noninfectious adverse events (such as falls and decubitus ulcers), patient dissatisfaction, and prolonged length of stay. “MRSA infections can be controlled without active surveillance…. ADI should be viewed as an option of last resort to control multidrug-resistant organisms,” said Dr. Edmond, chair of the division of infectious diseases at Virginia Commonwealth University Medical Center, Richmond.

The study setting was an 820-bed urban academic medical center. The interventions were initiated over more than a decade, starting in 1998 with concurrent surveillance for health care–associated infections (HAIs) in ICUs. Antiseptic-coated central venous catheters (CVCs) were introduced in 2002. In 2004, an ICU hand hygiene campaign was introduced.

Active interventions began in 2006, mandatory house staff education on CVC insertion. Roving “hand hygiene observers” were instituted hospitalwide in 2007, chlorhexidine bathing of ICU patients in 2008, and a “bare below the elbows” recommendation in 2009, which banned sleeves below the elbows, as well as ties or lab coats that serve to transmit germs.

Device-related infection rates per 1,000 ICU patient-days actually rose slightly from 1998 until 2003, from 16.8 to 21.4. But after that the rate dropped steadily, from 18.0 in 2004 to 9.4 in 2006, to 5.8 in 2008 and just 3.3 in 2009. Overall there was an 83% reduction from 2003 through 2009, Dr. Edmond and his colleagues found.

Other MRSA HAI rates also declined. Central line–associated bloodstream infections dropped by 85%, catheter-associated urinary tract infections by 60%, and ventilator-associated pneumonia by 86%.

The overall MRSA infection rate in all medical, surgical, and neuroscience ICUs dropped by 93% from 2003 to 2009, from 2.86 to 0.21/1,000 patient-days. The percentage of HAIs due to MRSA in those settings dropped from 11.7 in 2003 to 5.1 in 2009. And for the first time ever, in the latter half of 2009 there were no device-associated MRSA HAIs in any of the hospital's eight adult, pediatric, and neonatal ICUs, Dr. Edmond reported.

Disclosures: Dr. Edmond disclosed financial relationships with BioVigil and Cardinal Health.

My Take

Low-Tech Interventions Can Help

This hospital achieved dramatic results in an observational study, although it's possible that the improvement could represent a low performance level prior to the interventions.

In general, hospitalists are not involved in using active detection and isolation strategies for MRSA. I think the take-home message for hospitalists is that there are low-tech interventions that they can implement to reduce health care–associated infections:

▸ Antiseptic-coated central venous catheters (CVCs).

▸ Hand hygiene with roving observers.

▸ Feedback on health care–associated infections and infection-control practices.

▸ Mandatory house staff education on CVC insertion, focusing on good sterile technique.

▸ Chlorhexidine bathing of ICU patients.

▸ “Bare below the elbows” rules, which ban sleeves below the elbows, as well as ties or lab coats that serve to transmit germs.

FRANKLIN A. MICHOTA, M.D., is the director of academic affairs in the Department of Hospital Medicine at the Cleveland Clinic. He reported no relevant conflicts of interest.

A hospital-based strategy using multiple infection-control interventions resulted in more than a 90% reduction in health care–associated infections due to methicillin-resistant Staphylococcus aureus without the need for active MRSA surveillance.

Findings from a 7-year observational study add support to the argument that the controversial practice of active surveillance is excessively resource-intensive and of limited value because it targets only MRSA and not other common nosocomial pathogens, Dr. Michael Edmond said in a telebriefing held in advance of the Decennial International Conference on Healthcare-Associated Infections.

Other disadvantages and unintended consequences of so-called “active detection and isolation” (ADI) include high cost, ethical issues, increases in noninfectious adverse events (such as falls and decubitus ulcers), patient dissatisfaction, and prolonged length of stay. “MRSA infections can be controlled without active surveillance…. ADI should be viewed as an option of last resort to control multidrug-resistant organisms,” said Dr. Edmond, chair of the division of infectious diseases at Virginia Commonwealth University Medical Center, Richmond.

The study setting was an 820-bed urban academic medical center. The interventions were initiated over more than a decade, starting in 1998 with concurrent surveillance for health care–associated infections (HAIs) in ICUs. Antiseptic-coated central venous catheters (CVCs) were introduced in 2002. In 2004, an ICU hand hygiene campaign was introduced.

Active interventions began in 2006, mandatory house staff education on CVC insertion. Roving “hand hygiene observers” were instituted hospitalwide in 2007, chlorhexidine bathing of ICU patients in 2008, and a “bare below the elbows” recommendation in 2009, which banned sleeves below the elbows, as well as ties or lab coats that serve to transmit germs.

Device-related infection rates per 1,000 ICU patient-days actually rose slightly from 1998 until 2003, from 16.8 to 21.4. But after that the rate dropped steadily, from 18.0 in 2004 to 9.4 in 2006, to 5.8 in 2008 and just 3.3 in 2009. Overall there was an 83% reduction from 2003 through 2009, Dr. Edmond and his colleagues found.

Other MRSA HAI rates also declined. Central line–associated bloodstream infections dropped by 85%, catheter-associated urinary tract infections by 60%, and ventilator-associated pneumonia by 86%.

The overall MRSA infection rate in all medical, surgical, and neuroscience ICUs dropped by 93% from 2003 to 2009, from 2.86 to 0.21/1,000 patient-days. The percentage of HAIs due to MRSA in those settings dropped from 11.7 in 2003 to 5.1 in 2009. And for the first time ever, in the latter half of 2009 there were no device-associated MRSA HAIs in any of the hospital's eight adult, pediatric, and neonatal ICUs, Dr. Edmond reported.

Disclosures: Dr. Edmond disclosed financial relationships with BioVigil and Cardinal Health.

My Take

Low-Tech Interventions Can Help

This hospital achieved dramatic results in an observational study, although it's possible that the improvement could represent a low performance level prior to the interventions.

In general, hospitalists are not involved in using active detection and isolation strategies for MRSA. I think the take-home message for hospitalists is that there are low-tech interventions that they can implement to reduce health care–associated infections:

▸ Antiseptic-coated central venous catheters (CVCs).

▸ Hand hygiene with roving observers.

▸ Feedback on health care–associated infections and infection-control practices.

▸ Mandatory house staff education on CVC insertion, focusing on good sterile technique.

▸ Chlorhexidine bathing of ICU patients.

▸ “Bare below the elbows” rules, which ban sleeves below the elbows, as well as ties or lab coats that serve to transmit germs.

FRANKLIN A. MICHOTA, M.D., is the director of academic affairs in the Department of Hospital Medicine at the Cleveland Clinic. He reported no relevant conflicts of interest.

A hospital-based strategy using multiple infection-control interventions resulted in more than a 90% reduction in health care–associated infections due to methicillin-resistant Staphylococcus aureus without the need for active MRSA surveillance.

Findings from a 7-year observational study add support to the argument that the controversial practice of active surveillance is excessively resource-intensive and of limited value because it targets only MRSA and not other common nosocomial pathogens, Dr. Michael Edmond said in a telebriefing held in advance of the Decennial International Conference on Healthcare-Associated Infections.

Other disadvantages and unintended consequences of so-called “active detection and isolation” (ADI) include high cost, ethical issues, increases in noninfectious adverse events (such as falls and decubitus ulcers), patient dissatisfaction, and prolonged length of stay. “MRSA infections can be controlled without active surveillance…. ADI should be viewed as an option of last resort to control multidrug-resistant organisms,” said Dr. Edmond, chair of the division of infectious diseases at Virginia Commonwealth University Medical Center, Richmond.

The study setting was an 820-bed urban academic medical center. The interventions were initiated over more than a decade, starting in 1998 with concurrent surveillance for health care–associated infections (HAIs) in ICUs. Antiseptic-coated central venous catheters (CVCs) were introduced in 2002. In 2004, an ICU hand hygiene campaign was introduced.

Active interventions began in 2006, mandatory house staff education on CVC insertion. Roving “hand hygiene observers” were instituted hospitalwide in 2007, chlorhexidine bathing of ICU patients in 2008, and a “bare below the elbows” recommendation in 2009, which banned sleeves below the elbows, as well as ties or lab coats that serve to transmit germs.

Device-related infection rates per 1,000 ICU patient-days actually rose slightly from 1998 until 2003, from 16.8 to 21.4. But after that the rate dropped steadily, from 18.0 in 2004 to 9.4 in 2006, to 5.8 in 2008 and just 3.3 in 2009. Overall there was an 83% reduction from 2003 through 2009, Dr. Edmond and his colleagues found.

Other MRSA HAI rates also declined. Central line–associated bloodstream infections dropped by 85%, catheter-associated urinary tract infections by 60%, and ventilator-associated pneumonia by 86%.

The overall MRSA infection rate in all medical, surgical, and neuroscience ICUs dropped by 93% from 2003 to 2009, from 2.86 to 0.21/1,000 patient-days. The percentage of HAIs due to MRSA in those settings dropped from 11.7 in 2003 to 5.1 in 2009. And for the first time ever, in the latter half of 2009 there were no device-associated MRSA HAIs in any of the hospital's eight adult, pediatric, and neonatal ICUs, Dr. Edmond reported.

Disclosures: Dr. Edmond disclosed financial relationships with BioVigil and Cardinal Health.

My Take

Low-Tech Interventions Can Help

This hospital achieved dramatic results in an observational study, although it's possible that the improvement could represent a low performance level prior to the interventions.

In general, hospitalists are not involved in using active detection and isolation strategies for MRSA. I think the take-home message for hospitalists is that there are low-tech interventions that they can implement to reduce health care–associated infections:

▸ Antiseptic-coated central venous catheters (CVCs).

▸ Hand hygiene with roving observers.

▸ Feedback on health care–associated infections and infection-control practices.

▸ Mandatory house staff education on CVC insertion, focusing on good sterile technique.

▸ Chlorhexidine bathing of ICU patients.

▸ “Bare below the elbows” rules, which ban sleeves below the elbows, as well as ties or lab coats that serve to transmit germs.

FRANKLIN A. MICHOTA, M.D., is the director of academic affairs in the Department of Hospital Medicine at the Cleveland Clinic. He reported no relevant conflicts of interest.