Skip to main content

Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units

Abstract

Objective

To evaluate the effectiveness of screening strategy and contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA).

Design and setting

Prospective observational cohort from 1 February 1995 to 31 December 2001 in three intensive care units (45 beds) in a French teaching hospital.

Patients

8,548 patients admitted to the three ICUs had nasal screening on ICU admission and weekly thereafter. Contact precautions were used in MRSA-positive patients. The following variables were collected: age, gender, severity score, length of stay, workload, and colonization pressure (percentage of patient-days with an MRSA to the number of patient-days in the unit). Alcohol-based handrub solution was introduced in July 2000. We compared the period before this (P1) with that thereafter (P2).

Results

Of the 8,548 admitted patients 554 (6.5%) had MRSA at ICU admission, and 456 of the 7,515 (6.1%) exposed patients acquired MRSA. Acquisition incidence decreased from 7.0% in P1 to 2.8% in P2. Independent variables associated with MRSA acquisition were: age (adjusted odds ratio 1.013), severity score (1.047), length of ICU stay (1.015), colonization pressure (1.019), medical ICU (1.58), and P2 (0.49).

Conclusions

MRSA control in these ICUs characterized by a high prevalence of MRSA at admission was achieved via multiple factors, including screening, contact precautions, and use of alcoholic handrub solution. Our results after adjustment of risk factors for MRSA acquisition and the steady improvement in MRSA over several years strengthen these findings. MRSA spreading can be successfully controlled in ICUs with high colonization pressure.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, Beach M (2001) Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis 32:S114–S132

    Article  CAS  PubMed  Google Scholar 

  2. Centers for Disease Control, Prevention (2001) National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992–June 2001, issued August 2001. Am J Infect Control 29:404–421

    Article  PubMed  Google Scholar 

  3. The Hôpital Propre II study group (1999) Methicillin-resistant Staphylococcus aureus in French hospitals: A 2-month survey in 43 hospitals, 1995. The Hopital Propre II Study Group. Infect Control Hosp Epidemiol 20:478–486

    Article  PubMed  Google Scholar 

  4. Vincent JL (2000) Microbial resistance: lessons from the EPIC study. European prevalence of infection. Intensive Care Med 26 [Suppl 1]:S3–S8

    Article  Google Scholar 

  5. Vandenbroucke-Grauls CM (1996) Methicillin-resistant Staphylococcus aureus control in hospitals: the Dutch experience. Infect Control Hosp Epidemiol 17:512–513

    CAS  PubMed  Google Scholar 

  6. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM (2003) SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 24:362–386

    PubMed  Google Scholar 

  7. Girou E, Pujade G, Legrand P, Cizeau F, Brun-Buisson C (1998) Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 27:543–550

    CAS  PubMed  Google Scholar 

  8. Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, Duckworth G, Lai R, Ebrahim S (2004) Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 329:533

    Article  CAS  PubMed  Google Scholar 

  9. Boyce JM, Pittet D (2002) Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 23:S3–S40

    PubMed  Google Scholar 

  10. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 356:1307–1312

    Article  CAS  PubMed  Google Scholar 

  11. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    CAS  PubMed  Google Scholar 

  12. Sznajder M, Leleu G, Buonamico G, Auvert B, Aegerter P, Merliere Y, Dutheil M, Guidet B, Le Gall JR (1998) Estimation of direct cost and resource allocation in intensive care: correlation with Omega system. Intensive Care Med 24:582–589

    Article  CAS  PubMed  Google Scholar 

  13. Lucet JC, Decre D, Fichelle A, Joly-Guillou ML, Pernet M, Deblangy C, Kosmann MJ, Regnier B (1999) Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing enterobacteriaceae in a university hospital. Clin Infect Dis 29:1411–1418

    Article  CAS  PubMed  Google Scholar 

  14. Scanvic A, Denic L, Gaillon S, Giry P, Andremont A, Lucet JC (2001) Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 32:1393–1398

    Google Scholar 

  15. Garner JS (1996) Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 17:53–80

    CAS  PubMed  Google Scholar 

  16. Lucet JC, Chevret S, Durand-Zaleski I, Chastang C, Regnier B (2003) Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 163:181–188

    Article  PubMed  Google Scholar 

  17. Lucet JC, Rigaud MP, Mentre F, Kassis N, Deblangy C, Andremont A, Bouvet E (2002) Hand contamination before and after different hand hygiene techniques: a randomized clinical trial. J Hosp Infect 50:276–280

    Article  PubMed  Google Scholar 

  18. Rigaud MP, Deblangy C, Fargeot C, Descamps V, Abiteboul D, Lolom I, Andremont A, Bouvet E, Lucet JC (2002) Evaluation de la tolérance cutanée d’une solution hydro-alcoolique. HygièneS 10:11–15

    Google Scholar 

  19. Bonten MJ, Slaughter S, Ambergen AW, Hayden MK, van Voorhis J, Nathan C, Weinstein RA (1998) The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 158:1127–1132

    Article  CAS  PubMed  Google Scholar 

  20. Merrer J, Santoli F, Appere de Vecchi C, Tran B, De Jonghe B, Outin H (2000) “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 21:718–723

    CAS  PubMed  Google Scholar 

  21. Cepeda JA, Whitehouse T, Cooper B, Hails J, Jones K, Kwaku F, Taylor L, Hayman S, Cookson B, Shaw S, Kibbler C, Singer M, Bellingan G, Wilson AP (2005) Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 365:295–304

    PubMed  Google Scholar 

  22. Nijssen S, Bonten MJ, Weinstein RA (2005) Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis 40:405–409

    Google Scholar 

  23. Austin DJ, Bonten MJ, Weinstein RA, Slaughter S, Anderson RM (1999) Vancomycin-resistant enterococci in intensive-care hospital settings: transmission dynamics, persistence, and the impact of infection control programs. Proc Natl Acad Sci U S A 96:6908–6913

    Article  CAS  PubMed  Google Scholar 

  24. Grundmann H, Hori S, Winter B, Tami A, Austin DJ (2002) Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data. J Infect Dis 185:481–488

    Article  PubMed  Google Scholar 

  25. Byers KE, Anglim AM, Anneski CJ, Germanson TP, Gold HS, Durbin LJ, Simonton BM, Farr BM (2001) A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 22:140–147

    CAS  PubMed  Google Scholar 

  26. Coello R, Jimenez J, Garcia M, Arroyo P, Minguez D, Fernandez C, Cruzet F, Gaspar C (1994) Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 13:74–81

    CAS  PubMed  Google Scholar 

  27. Cox RA, Conquest C, Mallaghan C, Marples RR (1995) A major outbreak of methicillin-resistant Staphylococcus aureus caused by a new phage-type (EMRSA-16). J Hosp Infect 29:87–106

    Article  CAS  PubMed  Google Scholar 

  28. British Society for Antimicrobial Chemotherapy, Hospital Infection Society and the Infection Control Nurses Association (1998) Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals. J Hosp Infect 39:253–290

    Article  PubMed  Google Scholar 

  29. Société de réanimation de langue française (2002) Recommandations des experts de la Société de réanimation de langue française, janvier 2002: prévention de la transmission croisée en réanimation. Réanimation Soins Intensifs Med Urgence 11:250–256

  30. Asensio A, Guerrero A, Quereda C, Lizan M, Martinez-Ferrer M (1996) Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 17:20–28

    CAS  PubMed  Google Scholar 

  31. Boyce JM, Havill NL, Kohan C, Dumigan DG, Ligi CE (2004) Do infection control measures work for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 25:395–401

    PubMed  Google Scholar 

  32. Tomic V, Svetina Sorli P, Trinkaus D, Sorli J, Widmer AF, Trampuz A (2004) Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med 164:2038–2043

    Article  PubMed  Google Scholar 

  33. Graffunder EM, Venezia RA (2002) Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother 49:999–1005

    Article  CAS  PubMed  Google Scholar 

  34. Weber SG, Gold HS, Hooper DC, Karchmer AW, Carmeli Y (2003) Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis 9:1415–1422

    PubMed  Google Scholar 

Download references

Acknowledgements

We thank Catherine Fargeot, PhD (Pharmacy Unit), for providing pharmacy data, Nadine Sauteret (Infection Control Unit), Cécile Durand-Stocco and Pascal Giry (Hospital Information System) for managing administrative data, and the staff of the three intensive care units for their active and valuable participation.

Conflict of interest:

No information supplied

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jean-Christophe Lucet.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lucet, JC., Paoletti, X., Lolom, I. et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 31, 1051–1057 (2005). https://doi.org/10.1007/s00134-005-2679-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-005-2679-0

Keywords

  • Staphylococcus aureus
  • Methicillin resistance
  • Intensive care units
  • Prevention and control