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

Objectives. 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)

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

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  1. Objectives • 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. Chazan B1, Teitler N1, Colodner R1, Nitzan O1, Edelstein H1, Raz R1, 2 1Haemek Medical Center, Afula, and 2Rappaport Faculty of Medicine, Haifa, Israel Background: 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 Ha’Emek 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). >90% 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) (p<0.01). 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 SWABS / CULTURES / SWAB CULTURES?5 Active surveillance and decolonization of MRSA carriers as a tool for MRSA bacteremia reduction • 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). Methods: Results • The study was conducted at the Ha’Emek 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. • 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) (p<0.01). 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. chazan_b@clalit.org.il

  2. Objectives • 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. Chazan B1, Teitler N1, Colodner R1, Nitzan O1, Edelstein H1, Raz R1, 2 1Haemek Medical Center, Afula, and 2Rappaport Faculty of Medicine, Haifa, Israel Background: 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 Ha’Emek 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). >90% 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) (p<0.01). 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 SWABS / CULTURES / SWAB CULTURES?5 Active surveillance and decolonization of MRSA carriers as a tool for MRSA bacteremia reduction • 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). Methods: Results • The study was conducted at the Ha’Emek 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. • 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) (p<0.01). 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. chazan_b@clalit.org.il

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