Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T16:51:35.220Z Has data issue: false hasContentIssue false
  • English
  • Français

Reduction in Hospitalwide Incidence of Infection or Colonization with Methicillin-Resistant Staphylococcus aureus With Use of Antimicrobial Hand-Hygiene Gel and Statistical Process Control Charts

Published online by Cambridge University Press:  02 January 2015

Glenys Harrington ,
Kerrie Watson ,
Michael Bailey ,
Gillian Land ,
Susan Borrell ,
Leanne Houston ,
Rosaleen Kehoe ,
Pauline Bass ,
Emma Cockroft  and
Caroline Marshall
...Show all authors
Glenys Harrington*
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Kerrie Watson
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Michael Bailey
Affiliation:
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Gillian Land
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Susan Borrell
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Leanne Houston
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Rosaleen Kehoe
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Pauline Bass
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia
Emma Cockroft
Affiliation:
Infectious Diseases Unit, Alfred Hospital, Bayside Health, Melbourne, Australia
Caroline Marshall
Affiliation:
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia Centre for Clinical Research Excellence in Infectious Diseases, University of Melbourne, Melbourne, Australia
Anne Mijch
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia Infectious Diseases Unit, Alfred Hospital, Bayside Health, Melbourne, Australia
Denis Spelman
Affiliation:
Infection Control and Hospital Epidemiology Unit, Melbourne, Australia Infectious Diseases Unit, Alfred Hospital, Bayside Health, Melbourne, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
*
Infection Control and Hospital Epidemiology Unit, Alfred Hospital, Commercial Rd., Melbourne, Victoria 3004, Australia (I.Control@alfred.org.au)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the impact of serial interventions on the incidence of methicillin-resistant Staphylococcus aureus (MRSA).

Design.

Longitudinal observational study before and after interventions.

Setting.

The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU).

Interventions.

A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures.

Methods.

Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period.

Results.

The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P = .047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P < .001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively.

Conclusion.

A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 837 - 844
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Nimmo, GR, Coombs, GW, Pearson, JC, et al.Methicillin-resistant Staphylococcus aureus in the Australian community: an evolving epidemic. Med J Aust 2006;184:384–388.CrossRefGoogle ScholarPubMed
2.Collignon, P, Nimmo, GR, Gottlieb, T, Gosbell, IB. Staphylococcus aureus bacteraemia, Australia. Emerg Infect Dis 2005;11:554–561.CrossRefGoogle ScholarPubMed
3.Marshall, C, Harrington, G, Wolfe, R, Fairley, CK, Wesselingh, S, Spelman, D. Acquisition of methicillin-resistant Staphylococcus aureus in a large intensive care unit. Infect Control Hosp Epidemiol 2003;24:322–326.CrossRefGoogle Scholar
4.Farr, BM, Bellingham, G. Pro/con clinical debate: isolation precautions for all intensive care unit patients with methicillin-resistant Staphylococcus aureus colonisation are essential. Crit Care 2004;8:153–156.CrossRefGoogle ScholarPubMed
5.Muto, CA. Methicillin-resistant Staphylococcus aureus control: we didn't start the fire, but it's time to put it out. Infect Control Hosp Epidemiol 2006;27:111–115.CrossRefGoogle ScholarPubMed
6.Sunenshine, R, Liedtke, LA, Fridkin, SK, Strausbaugh, LJ. Management of inpatients colonized or infected with antimicrobial-resistant bacteria in hospitals in the United States. Infect Control Hosp Epidemiol 2005;26:138–143.CrossRefGoogle ScholarPubMed
7.Farr, BM. Prevention and control of methicillin-resistant Staphylococcus aureus infections. Curr Opin Infect Dis 2004;17:317–322.CrossRefGoogle ScholarPubMed
8.Boyce, IM, Havill, NL, Kohan, C, Dumingan, DG, Ligri, CE. Do infection control measures work for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2006;27:116–121.Google Scholar
9.Cooper, BS, Kibbler, CC, Cookson, BD, et al.Isolation measures in the hospital management of methicillin-resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 2004;329:533–539.CrossRefGoogle ScholarPubMed
10.Farr, B. What to think if results of the National Institutes of Health randomised trial of methicillin-resistant Staphylococcus aureus and van-comycin-resistant Enterococcus control measures are negative (and other advice to young epidemiologists): a review and an au revoir. Infect Control Hosp Epidemiol 2006;26:1098–1106.Google Scholar
11.Pittet, D, Hoougonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide program to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
12.Johnson, PD, Martin, R, Burrell, LJ, et al.Efficacy of an alcohol/chlor-hexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005;183:509–514.CrossRefGoogle Scholar
13.Siegel, JD, Rheinhart, E, Jackson, M, Chiarello, L, the Healthcare Infection Control Practice Advisory Committee. Management of Multi-Resistant Organisms in Healthcare Settings, 2006. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed November 12, 2006.Google Scholar
14.Humphrey, H. Control of methicillin-resistant Staphylococcus aureus in hospitals: an impossible dream? J Med Microbiol 2002;51:283–285.Google Scholar
15.Curran, ET, Benneyan, JC, Hood, J. Controlling methicillin-resistant Staphylococcus aureus: a feedback approach using annotated statistical process control charts. Infect Control Hosp Epidemiol 2002;23:13–18.CrossRefGoogle ScholarPubMed
16.Benneyan, IC, Lloyd, RC, Plsek, PE. Statistical process control as a tool for research and health care improvement. Qual Saf Health Care 2003;12:458–464.CrossRefGoogle Scholar
17.Lloyd, RC. Quality Health Care: A Guide to Developing and Using Indictors. 1st ed. Boston, MA: Jones and Bartlett; 2004:216.Google Scholar
18.Wadsworth, HM. Statistical process control. In: Juran, AM, Godfrey, AB. Juran's Quality Handbook. 5th ed. McGraw-Hill: Singapore; 2000:45.1–46.1.Google Scholar
19.Tibballs, J. Teaching hospital medical staff to handwash. Med J Aust 1996;164:14–17.CrossRefGoogle ScholarPubMed
20.Pittet, D. Hand hygiene: improved standards and practice for hospital care. Curr Opin Infect Dis 2003;16:327–335.CrossRefGoogle ScholarPubMed
21.Pittet, D, Mourouga, P, Perneger, TV, Members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.CrossRefGoogle ScholarPubMed
22.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004:1659–1702.Google Scholar
23.Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27:299–309.CrossRefGoogle ScholarPubMed
24.Ansari, F, Gray, K, Nathwani, D, et al.Outcome of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. J Antimicrob Chemother 2003;52:842–848.CrossRefGoogle ScholarPubMed
25.Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999;282:1745–1751.CrossRefGoogle Scholar
26.Kim, T, Oh, PI, Simor, AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 2001;22:99–104.CrossRefGoogle ScholarPubMed
27.West, TE, Guerry, C, Hiott, M, et al.Effect of targeted surveillance for control of methicillin-resistant Staphylococcus aureus in a community hospital system. Infect Control Hosp Epidemiol 2006;27:233–238.CrossRefGoogle Scholar
28.Noble, T. The year ahead: health. The Age. January 3, 2004. Available at: http://www.theage.com.au/articles/2004/01/02/1072908911917.html. Accessed September 25, 2006.Google Scholar