Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/360
Título : Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers
Autor : Rodríguez-Baño, Jesús
García, Lola
Ramírez, Encarnación
Lupión, Carmen
Muniain, Miguel A.
Velasco, Carmen
Gálvez, Juan
del Toro, M. Dolores
Millán, Antonio B.
López-Cerero, Lorena
Pascual, Álvaro
Filiación: [Rodríguez-Baño,J; García,L; Lupión,C; Muniain,MA; Gálvez,J; del Toro,MD; Millán,AB] Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena. [Ramírez,E; López-Cerero,L; Pascual,A] Servicio de Microbiología, Hospital Universitario Virgen Macarena. [Rodríguez-Baño,J; Muniain,MA; Gálvez,J] Departamento de Medicina, Universidad de Sevilla. Sevilla, Spain. [Velaco,C; López-Cerero,L; Pascual,A] Departamento de Microbiología, Universidad de Sevilla. Sevilla, Spain.
Palabras clave : Methicillin-Resistant Staphylococcus aureus
Patients
Workers
Staphylococcus aureus Resistente a Meticilina
Pacientes
Trabajadores
MeSH: Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Bacteremia
Medical Subject Headings::Health Care::Environment and Public Health::Public Health::Endemic Diseases
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Personnel::Infection Control Practitioners
Medical Subject Headings::Named Groups::Persons::Patients::Inpatients
Medical Subject Headings::Organisms::Bacteria::Endospore-Forming Bacteria::Gram-Positive Endospore-Forming Bacteria::Gram-Positive Endospore-Forming Rods::Staphylococcaceae::Staphylococcus::Staphylococcus aureus::Methicillin-Resistant Staphylococcus aureus
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Health Surveys::Population Surveillance
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Program Evaluation
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Positive Bacterial Infections::Staphylococcal Infections
Fecha de publicación : 31-Aug-2010
Editorial : The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America
Cita Bibliográfica: Rodríguez-Baño J, García L, Ramírez E, Lupión C, Muniain MA, Velasco C, et al. Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers. Infect Control Hosp Epidemiol 2010; Vol. 31, No. 8 (August 2010), pp. 786-795
Abstract: To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation. DESIGN:Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis. SETTING:A 950-bed teaching hospital in Seville, Spain. PATIENTS:All patients admitted to the hospital during the period from 1995 through 2008. METHODS:Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers. RESULTS:Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care. CONCLUSION:Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.
URI: http://hdl.handle.net/10668/360
Versión del editor : http://www.jstor.org/stable/10.1086/654003
DOI: 10.1086/654003
ISSN : 0899-823X (Print)
1559-6834 (Online)
Appears in Collections:01- Artículos - Hospital Virgen Macarena

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