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Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial

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,...

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Autores principales: Lee, Andie S, Cooper, Ben S, Malhotra-Kumar, Surbhi, Chalfine, Annie, Daikos, George L, Fankhauser, Carolina, Carevic, Biljana, Lemmen, Sebastian, Martínez, José Antonio, Masuet-Aumatell, Cristina, Pan, Angelo, Phillips, Gabby, Rubinovitch, Bina, Goossens, Herman, Brun-Buisson, Christian, Harbarth, Stephan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780302/
https://www.ncbi.nlm.nih.gov/pubmed/24056477
http://dx.doi.org/10.1136/bmjopen-2013-003126
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author Lee, Andie S
Cooper, Ben S
Malhotra-Kumar, Surbhi
Chalfine, Annie
Daikos, George L
Fankhauser, Carolina
Carevic, Biljana
Lemmen, Sebastian
Martínez, José Antonio
Masuet-Aumatell, Cristina
Pan, Angelo
Phillips, Gabby
Rubinovitch, Bina
Goossens, Herman
Brun-Buisson, Christian
Harbarth, Stephan
author_facet Lee, Andie S
Cooper, Ben S
Malhotra-Kumar, Surbhi
Chalfine, Annie
Daikos, George L
Fankhauser, Carolina
Carevic, Biljana
Lemmen, Sebastian
Martínez, José Antonio
Masuet-Aumatell, Cristina
Pan, Angelo
Phillips, Gabby
Rubinovitch, Bina
Goossens, Herman
Brun-Buisson, Christian
Harbarth, Stephan
author_sort Lee, Andie S
collection PubMed
description 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
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spelling pubmed-37803022013-09-30 Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial Lee, Andie S Cooper, Ben S Malhotra-Kumar, Surbhi Chalfine, Annie Daikos, George L Fankhauser, Carolina Carevic, Biljana Lemmen, Sebastian Martínez, José Antonio Masuet-Aumatell, Cristina Pan, Angelo Phillips, Gabby Rubinovitch, Bina Goossens, Herman Brun-Buisson, Christian Harbarth, Stephan BMJ Open Infectious Diseases 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 BMJ Publishing Group 2013-09-19 /pmc/articles/PMC3780302/ /pubmed/24056477 http://dx.doi.org/10.1136/bmjopen-2013-003126 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 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/
spellingShingle Infectious Diseases
Lee, Andie S
Cooper, Ben S
Malhotra-Kumar, Surbhi
Chalfine, Annie
Daikos, George L
Fankhauser, Carolina
Carevic, Biljana
Lemmen, Sebastian
Martínez, José Antonio
Masuet-Aumatell, Cristina
Pan, Angelo
Phillips, Gabby
Rubinovitch, Bina
Goossens, Herman
Brun-Buisson, Christian
Harbarth, Stephan
Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
title Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
title_full Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
title_fullStr Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
title_full_unstemmed Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
title_short Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
title_sort comparison of strategies to reduce meticillin-resistant staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
topic Infectious Diseases
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780302/
https://www.ncbi.nlm.nih.gov/pubmed/24056477
http://dx.doi.org/10.1136/bmjopen-2013-003126
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