Universal Surveillance for Methicillin-Resistant Staphylococcus aureus in 3 Affiliated Hospitals

Robicsek, Ari; Beaumont, Jennifer L.; Paule, Suzanne M.; Hacek, Donna M.; Thomson, Richard B.; Kaul, Karen L.; King, Peggy; Peterson, Lance R.

doi:10.7326/0003-4819-148-6-200803180-00003

Cited by 398 publications

(284 citation statements)

References 27 publications

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“…First, use of these readily available data sets cannot account for all factors associated with infection risk, such as invasive device use or proportion of intensive care unit admissions, which have been shown to be associated with MRSA carriage and infection. 32,35,36 Second, use of these data sets is subject to further validation studies. Despite validated methodology for its use in identifying patient comorbidities,17 a previous version of MRSA ICD-9 codes has been shown to have limitations in ascertainment of MRSA disease.37,38 Although our study uses more recently revised MRSA ICD-9 codes (updated in 2008) meant to increase the specificity and sensitivity for capturing MRSA infection, other databases-such as the Center for Disease Control's National Healthcare Safety Net-work-could be used for identifying HA-MRSA infections.…”

Section: Discussionmentioning

confidence: 99%

Substantial Shifts in Ranking of California Hospitals by Hospital-Associated Methicillin-ResistantStaphylococcus aureusInfection Following Adjustment for Hospital Characteristics and Case Mix

Tehrani

Phelan

Cao

et al. 2014

Infect. Control Hosp. Epidemiol.

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BACKGROUND.States have established public reporting of hospital-associated (HA) infectionsincluding those of methicillin-resistant Staphylococcus aureus (MRSA)-but do not account for hospital case mix or postdischarge events. OBJECTIVE.Identify facility-level characteristics associated with HA-MRSA infection admissions and create adjusted hospital rankings. METHODS.A retrospective cohort study of 2009-2010 California acute care hospitals. We defined HA-MRSA admissions as involving MRSA pneumonia or septicemia events arising during hospitalization or within 30 days after discharge. We used mandatory hospitalization and US Census data sets to generate hospital population characteristics by summarizing across admissions. Facility-level factors associated with hospitals' proportions of HA-MRSA infection admissions were identified using generalized linear models. Using state methodology, hospitals were categorized into 3 tiers of HA-MRSA infection prevention performance, using raw and adjusted values. RESULTS. Among 323 hospitals, a median of 16 HA-MRSA infections (range, 0-102) per 10,000 admissions was found. Hospitals serving a greater proportion of patients who had serious comorbidities, were from low-education zip codes, and were discharged to locations other than home were associated with higher HA-MRSA infection risk. Total concordance between all raw and adjusted hospital rankings was 0.45 (95% confidence interval, 0.40-0.51). Among 53 community hospitals in the poorperformance category, more than 20% moved into the average-performance category after adjustment. Similarly, among 71 hospitals in the superior-performance category, half moved into the average-performance category after adjustment. CONCLUSIONS. When adjusting for nonmodifiable facility characteristics and case mix, hospital rankings based on HA-MRSA infections substantially changed. Quality indicators for hospitals require adequate adjustment for patient population characteristics for valid interhospital performance comparisons.

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Section: Discussionmentioning

confidence: 99%

Substantial Shifts in Ranking of California Hospitals by Hospital-Associated Methicillin-ResistantStaphylococcus aureusInfection Following Adjustment for Hospital Characteristics and Case Mix

Tehrani

Phelan

Cao

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…Estudos avaliaram a vigilância ativa por meio da cultura em swab nasal e/ou de orofaringe e demonstraram que esta medida contribui para redução das taxas de infecção (5)(6) .…”

Section: Introductionunclassified

Resistência à mupirocina entre isolados de Staphylococcus aureus de profissionais de enfermagem

et al. 2010

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RESUMO ABSTRACT Objectives:To assess colonization by Staphylococcus aureus sensitive and resistant to methicillin found in the saliva of nurses and, to recognize the mupirocin profile of resistance. Methods: It was collected three saliva samples of 356 (94.2%) professional research participants, totaling 1068 samples processed. All ethical aspects were covered. Microbiological analysis included the phenotypic identification, according to the standards of the Clinical and Laboratory Standards Institute. Results: In the first collection were obtained 73 individuals colonized by Staphylococcus aureus, 48 in the second and 37 in the third, totaling 158 samples of Staphylococcus aureus. Of these, 24 (15.2%) were resistant to oxacillin and 30 resistant to mupirocin (18.9%). Mupirocin resistance was observed sharply in the Staphylococcus aureus resistant to methicillin (MRSA); of 24 MRSA, 17 (70.8%) were resistant to this antibiotic. Conclusion: The results indicated that mupirocin resistance is a major problem since this antibiotic is an excellent ally in the measures taken to control infection in health services. Keywords: Staphylococcus aureus; Drug resistance, multiple; Mupirocin ; Nursing team RESUMEN Objetivos: Evaluar la colonización por Staphylococcus aureus sensibles y resistentes al meticilín en la saliva de profesionales de enfermería y, reconocer el perfil de resistencia a la mupirocina. Métodos: Fueron recolectadas tres muestras de saliva de 356 (94,2%) profesionales participantes de la investigación, totalizando 1.068 muestras procesadas. Todos los aspectos éticos fueron contemplados. El análisis microbiológico comprendió la identificación fenotípica, según normas del Clinical and Laboratory Standards Institute. Resultados: Fueron obtenidos 73 individuos colonizados por Staphylococcus aureus en la primera recolección, 48 en la segunda y 37 en la tercera, sumando 158 muestras aisladas de Staphylococcus aureus. De esas, 24 (15,2%) eran resistentes a la oxacilina y 30 resistentes a al mupirocina (18,9%). La resistencia al mupirocina fue observada de forma pronunciada en los Staphylococcus aureus resistentes a la metacilina (MRSA); de los 24 MRSA, 17 (70,8%) se presentaron resistentes a este antimicrobiano. Conclusión: Los resultados indicaron que la resistencia a la mupirocina es un importante problema, ya que ese antibiótico es un excelente aliado en las medidas de control de las infecciones de servicios de salud.

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“…15 For other nosocomial pathogens, such as methicillin-resistant Staphylococcus aureus, universal screening at admission has resulted in reduced rates of hospital-acquired infections. 16 Recent advances in diagnostic testing for C. difficile have encouraged the evaluation of the feasibility of screening patients at admission for C. difficile and subsequent application of isolation precautions. [17][18][19] An outcome model identified C. difficile screening, coupled with isolation precautions, as a cost-effective intervention when the proportion of admitted patients with C. difficile colonization was greater than approximately 10%.…”

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confidence: 99%

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

Lanzas

Dubberke

2014

Infect. Control Hosp. Epidemiol.

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ObjectiveBoth asymptomatic and symptomatic Clostridium difficile carriers contribute to new colonizations and infections within a hospital, but current control strategies focus only on preventing transmission from symptomatic carriers. Our objective was to evaluate the potential effectiveness of methods targeting asymptomatic carriers to control C. difficile colonization and infection (CDI) rates in a hospital ward: screening patients at admission to detect asymptomatic C. difficile carriers and placing positive patients into contact precautions.MethodsWe developed an agent-based transmission model for C. difficile that incorporates screening and contact precautions for asymptomatic carriers in a hospital ward. We simulated scenarios that vary according to screening test characteristics, colonization prevalence, and type of strain present at admission.ResultsIn our baseline scenario, on average, 42% of CDI cases were community-onset cases. Within the hospital-onset (HO) cases, approximately half were patients admitted as asymptomatic carriers who became symptomatic in the ward. On average, testing for asymptomatic carriers reduced the number of new colonizations and HO-CDI cases by 40%–50% and 10%–25%, respectively, compared with the baseline scenario. Test sensitivity, turnaround time, colonization prevalence at admission, and strain type had significant effects on testing efficacy.ConclusionsTesting for asymptomatic carriers at admission may reduce both the number of new colonizations and HO-CDI cases. Additional reductions could be achieved by preventing disease in patients who are admitted as asymptomatic carriers and developed CDI during the hospital stay.

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Universal Surveillance for Methicillin-Resistant Staphylococcus aureus in 3 Affiliated Hospitals

Abstract: Background:The effect of large-scale expanded surveillance for methicillin-resistant Staphylococcus aureus (MRSA) on health careassociated MRSA disease is not known.

Cited by 398 publications

References 27 publications

Substantial Shifts in Ranking of California Hospitals by Hospital-Associated Methicillin-ResistantStaphylococcus aureusInfection Following Adjustment for Hospital Characteristics and Case Mix

Substantial Shifts in Ranking of California Hospitals by Hospital-Associated Methicillin-ResistantStaphylococcus aureusInfection Following Adjustment for Hospital Characteristics and Case Mix

Resistência à mupirocina entre isolados de Staphylococcus aureus de profissionais de enfermagem

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

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