Active surveillance and decolonization of MRSA carriers as a tool for MRSA bacteremia reduction

1
Active surveillance and decolonization of MRSA
carriers as a tool for MRSA bacteremia reduction

• B. CHAZAN, N. TEITLER, R. COLODNER, O. NITZAN, H.
  EDELSTEIN, R. RAZ

Ha Emek Medical Center Afula Israel
2
Abstract

• Background
• Methicillin resistant Staphylococcus
  aureus (MRSA) is endemic in Israel's hospitals.
  Patients (pts) colonized with MRSA are a
  reservoir for spreading the bacteria and self
  infection. Active surveillance (AS) is an
  infection control measure used in order to reduce
  MRSA invasive infection.
• Since 2001 we conducted an-ongoing bacteremia (B)
  surveillance in our hospital, and noticed a
  continuous rise in MRSA B rates 22.9, 16.7,
  30.8, 32.7, 36.8 (2001 to 2005).
• Material and methods
• The study was conducted at the HaEmek Medical
  Center, a community teaching hospital in northern
  Israel serving a population of 500,000
  inhabitants.
• An AS of MRSA carriers was implemented since
  2004. Risk groups for MRSA colonization at
  admission were defined long term care facility
  residents (LTCFR) and pts. hospitalized in the
  prior 3 months.
• Nostrils, peri-anal and armpit cultures were
  obtained, and contact isolation was implemented
  pending results. Decolonization (DC) protocol was
  applied to MRSA carriers.
• Results
• MRSA carriers were found in 25 of LTCFR, 20 and
  33 of readmission pts. (from our other
  hospitals respectively). gt90 of the carriers
  were identified by nose and peri-anal cultures
  without additional benefit of armpits cultures,
  thus policy was changed to nose and peri-anal
  swabs alone. DC procedures were carried out in
  pts during hospitalization.
• Following the intervention the rate of MRSA B
  decline from 32.7 (2004) to 10.3 (2007)
  (plt0.01).
• Conclusions
• Ongoing B surveillance is an excellent tool to
  identify changes in antimicrobial
  susceptibilities
• Nasal and peri-anal swab cultures identified most
  MRSA carriers
• Contact isolation and DC of MRSA carriers
  contributed to the decrease of MRSA B rates
• Infection control measures are mandatory in order
  to keep lower levels of MRSA B

3
Background

• Methicillin resistant Staphylococcus aureus
  (MRSA) is endemic in Israel's hospitals. Patients
  colonized with MRSA are a reservoir for spreading
  the bacteria and become infected themselves.
• Active surveillance is one of the infection
  control measures that aim to reduce the level of
  MRSA distribution and invasive infection.
• Since 2001 we conducted an-ongoing bacteremia
  surveillance in our hospital, and noticed a
  continuous rise in MRSA B rates 22.9, 16.7,
  30.8, 32.7, 36.8 (2001 to 2005).

4
Objectives

• Active surveillance to identify patients
  colonized with Methicillin resistant
  Staphylococcus aureus (MRSA) at admission.
• To implement a policy of
• Contact isolation of high risk patients for MRSA
  colonization (until culture results were
  obtained)
• Decolonization of patients with MRSA positive
  cultures .
• To evaluate if a search and destroy policy is
  an effective tool to stop the increase in MRSA
  bacteremia rates.

5
Methods

• The study was conducted at the HaEmek Medical
  Center, a community teaching hospital in northern
  Israel serving a population of 500,000
  inhabitants.
• An active surveillance of MRSA carriers was
  implemented since 2004.
• Risk groups for MRSA colonization at admission
  were defined
• Long term care facility residents.
• Prior hospitalized in in another hospital (3
  months).
• Readmission from our hospital ( 3 months).
• Nostrils, peri-anal and armpit cultures were
  obtained.
• Contact isolation in the patientws room was
  implemented pending results.
• Decolonization protocol was applied to MRSA
  carriers
• Nasal Mupirocin twice daily for 5 days in each
  nostril
• Daily shower with chlorhexidine gluconate 4
• All consecutives episodes of Staphylococcus
  aureus bacteremia (MSSA and MRSA) since 1.1.2001
  until 31.12.2007 were registered.

6
Results

• The rate of MRSA colonization was
• 25 in long term care facility residents.
• 20 in readmitted patients.
• 33 in patients hospitalized previously in
  another hospital.
• Nose and perianal cultures identified more than
  90 of MRSA carriers, while armpits did not
  improve the sensitivity of the surveillance.
• No significant changes were observed in the rate
  of S. aureus bacteremia (11.2 in 2001, 9.2 in
  2007).
• Decontamination procedures were carried out in
  all hospitalized patients identified as MRSA
  carriers.
• Following the intervention the rate of MRSA
  bacteremia decline from 32.7 (2004) to 10.3
  (2007) (plt0.01).

7
Frequency of bacteremia by year 2001-2007 all
isolates Vs. S. aureus (MSSA and MRSA) (N.S. for
all)
8
Frequency of S. aureus bacteremia by year
2001-2007 of MSSA Vs MRSA isolates
p 0.01 between 2004 and 2007
9
Conclusions

• Ongoing bacteremia surveillance is an excellent
  tool to identify changes in antimicrobial
  susceptibilities
• No significant changes were found in the
  frequency of bacteremic isolates as in the rate
  of S. aureus bacteremia through seven years
  surveillance.
• The rate of MRSA colonization was lower in
  readmitted patients, higher in long term care
  facility residents and highest in patients coming
  from another hospital.
• Nasal and peri-anal swab cultures identified most
  MRSA carriers.
• A policy of search and destroy (contact
  isolation and decontamination of MRSA carriers)
  contributed not only to halt the increasing rate
  in MRSA bacteremic isolates but to decrease this
  worrisome trend.
• Infection control measures are mandatory in order
  to keep these lower levels of MRSA bacteremia.