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Experts discuss reducing MRSA transmission in health care setting
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While MRSA remains a major threat to patients in the health care setting, invasive MRSA infection rates within this environment decreased by 54% between 2005 and 2011, according to the CDC.
Infectious Disease News and Healio.com/ID asked experts in the field to discuss the various policies and procedures in place at their institutions aimed at further reducing the spread of MRSA.
Michael S. Calderwood, MD, MPH
Brigham and Women’s Hospital
Harvard Medical School
Michael S. Calderwood
In addition to promoting compliance with hand hygiene and use of contact precautions for MRSA-colonized or infected patients throughout our hospital, we currently perform admission and weekly surveillance for MRSA colonization on all patients admitted to both our ICUs and our oncology and bone marrow transplant services. We also currently perform daily chlorhexidine bathing on all patients hospitalized in an ICU. This is based on the work of Climo and colleagues and Huang and colleagues showing reductions in acquisition of multidrug-resistant pathogens and overall bloodstream infections following universal decolonization in adult ICUs. It is important to note, however, that the study by Huang and colleagues included the use of intranasal mupirocin ointment in addition to daily chlorhexidine bathing. While both studies showed a reduction in rates of MRSA clinical isolates, the reduction only reached statistical significance in the Huang study. At the present time, we have not added mupirocin to our universal decolonization protocol in the adult ICUs. This is due to concerns about selecting for mupirocin resistance, but this is a highly debated topic.
We also engage with housekeeping staff to ensure adequate cleaning of the environment. This involves education, the use of checklists, and periodic observations using an invisible fluorescent marker that glows under a black light to monitor areas that are frequently missed in cleaning (Carling and colleagues). Previous research has demonstrated that the risk of MRSA acquisition is higher if the prior room occupant was MRSA positive, but that this risk disappears with improvements in environmental cleaning (Huang and colleagues; Datta and colleagues). Other institutions have used both UV light therapy and hydrogen peroxide technology to reduce environmental contamination and cross-transmission via contaminated surfaces. More data is needed to better understand the cost effectiveness of these newer technologies.
Reference:
Climo MW, et al. N Engl J Med. 2013;368:533-542.
Carling PC, et al. Clin Infect Dis. 2006;42:385-388.
Datta R, et al. Arch Intern Med. 2011;171:491-494.
Huang SS, et al. N Engl J Med. 2013;368:2255-2265.
Huang SS, et al. Arch Intern Med. 2006; 166:1945-1951.
Aaron M. Milstone, MD
Johns Hopkins Children’s Center
Aaron M. Milstone
In Baltimore, we have a high prevalence of MRSA infections — we have therefore tried to be proactive to screen and utilize contact precautions for our patients with MRSA colonization or infection. We start with encouraging hand hygiene, identifying patients that come into our hospital that are either colonized or infected with MRSA, and we flag them in our electronic medical records so that we know to place them in contact isolation at any point and time that they are being treated at our institution. With contact precaution, our health care workers are to wear gowns and gloves when treating these patients. We also conduct surveillance in some of our units, such as our ICUs, where we identify patients colonized with MRSA so that we can appropriately isolate them, and in some environments, we even decolonize our patients to eradicate MRSA. One of the advantages we have in place at our institution within the past year is that we have private patient rooms — almost all of our beds are in private rooms. We are very fortunate to have this. Another key component is education for all health care workers.
Loren G. Miller, MD, MPH
David Geffen School of Medicine, University of California, Los Angeles
The prevention of MRSA transmission is multifactorial — there is no one thing that is going to prevent or reduce MRSA transmission rates. However, some of the key prevention efforts in place at our institution include hand hygiene and screening and isolation for MRSA. In our ICU, we conduct daily chlorhexidine bathing to prevent MRSA transmission among patients.
Loren G. Miller