Reduction of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection by Cohorting Patients in a Dedicated Unit

Abstract

vaccine has been reported as approximately 80%, which is considered inadequate to provide population protection. Previous studies have shown that the effectiveness of 2 doses of vaccine is from 88% to 95%. 8,9 The estimated herd immunity threshold for mumps ranges from 88% to 92%. 10Although there was no single explanation for this outbreak, multiple factors may have contributed; these factors include waning immunity, vaccine failure, high population density and high contact rates in colleges, and incomplete vaccineinduced immunity to the wild virus. The relatively advanced age of the majority of infected patients points toward the waning immunity hypothesis. However, more research is needed to study the long-term vaccine effectiveness.In our study, all the subjects had received 2 doses of MMR vaccine, and yet 16 HCWs were found to be seronegative. In a recent measles outbreak, an unvaccinated HCW became infected in a hospital. Of 64 people with confirmed cases of measles, 17 became infected while visiting the healthcare facility."A limitation of our study is the small sample size; we did not include all the HCWs employed. Therefore, the results may underestimate the number of susceptible HCWs already employed.Mumps should be considered a reemerging yet vaccinepreventable disease, with transmission occurring in both healthcare and community settings. Future studies should include all HCWs, to better assess mumps seroprevalence in healthcare institutions. In view of the possible waning immunity, it is essential to carry out periodic serological surveillance and to vaccinate susceptible HCWs.

A veterinary perspective on methicillin-resistant staphylococci

“…Colonization of an individual may be either transient, persistent, or may not occur despite repeated exposure to S. aureus 1 . Colonized (or infected) humans may transmit MSSA or MRSA via direct contact or through fomites; the colonized person responsible for spread of the pathogen may be another patient in a healthcare setting, a health care provider, or a close contact (eg, family member, teammate, or pet) 83–87 …”

Improving clinical practice in the management of elderly patients hospitalized with antimicrobial resistant organisms

“…It is also [12] . Elderly patients who are colonized without signs of infection do not need to be isolated on their own, thus cohorting these patients could reduce the experience of confinement and claustrophobia [14,30] . Nursing staff need to differentiate between colonized and infectious patients, as 70%-80% of patients with AROs are over 65 years old and more likely to be asymptomatically colonized with an organism for prolonged periods without infection [3,31] .…”

Quarantine, Isolation, and Cohorting: From Cholera toKlebsiella

“…Doctor Barrett predicted that ''methicillin-resistant staphylococci will become more widespread in the United States and may present some clinical and epidemiologic problems in the future'' [19]. This forecast was correct: The following four decades were replete with instances of MRSA outbreaks in the community, hospital wards, nursing facilities, and, ubiquitously, medical, surgical, and neonatal intensive care units (ICUs) [15,[20][21][22][23][24][25][26][27]. The 1980s saw the arrival of MDROs expressing resistance to progressively newer antibiotics.…”

“…This has proved effective for disrupting outbreaks of MRSA [21,22,26,27], VRE [38,39,[41][42][43], ESBL-producing K. pneumoniae [30,[32][33][34], S. marcescens [44], Acinetobacter baumannii [31,[45][46][47], and P. aeruginosa [48].…”

“…Nearly ubiquitous to all outbreaks is the initial failure of standard isolation precautions, universal screening of new admissions, and the cohorting of nursing, ancillary staff, and patient care equipment [21,26,30,31,33,34,41,[45][46][47]50]. Other methods of outbreak control are unit closure [21,30,[42][43][44]48], hiring of additional staff or an infectious disease consultant [22,44], encouraging use of disposable equipment [42], and screening of staff and subsequent reassignment of those colonized to non-clinical duties [15,30,48].…”