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Horizontal Infection Control Strategy Decreases Methicillin-Resistant Staphylococcus aureus Infection and Eliminates Bacteremia in a Surgical ICU Without Active Surveillance*

Traa, Maria X. MD; Barboza, Lorena RN; Doron, Shira MD; Snydman, David R. MD, FIDSA; Noubary, Farzad PhD; Nasraway, Stanley A. Jr MD, FCCM

doi: 10.1097/CCM.0000000000000501
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Objective: Methicillin-resistant Staphylococcus aureus infection is a significant contributor to morbidity and mortality in hospitalized patients worldwide. Numerous healthcare bodies in Europe and the United States have championed active surveillance per the “search and destroy” model. However, this strategy is associated with significant economic, logistical, and patient costs without any impact on other hospital-acquired pathogens. We evaluated whether horizontal infection control strategies could decrease the prevalence of methicillin-resistant S. aureus infection in the ICU, without the need for active surveillance.

Design and Setting: Retrospective, observational study in the surgical ICU of a tertiary care medical center in Boston, MA, from 2005 to 2012.

Patients: A total of 6,697 patients in the surgical ICU.

Interventions: Evidence-based infection prevention strategies were implemented in an iterative fashion, including 1) hand hygiene program with refresher education campaign, 2) chlorhexidine oral hygiene program, 3) chlorhexidine bathing, 4) catheter-associated bloodstream infection program, and 5) daily goals sheets.

Measurements and Main Results: The prevalence of methicillin-resistant S. aureus infection fell from 2.66 to 0.69 per 1,000 patient days from 2005 to 2012, an average decrease of 21% per year. The biggest decline in rate of infection was detected in 2008, which may suggest that the catheter-associated bloodstream infection prevention program was particularly effective. Among 4,478 surgical ICU admissions over the last 5 years, not a single case of methicillin-resistant S. aureus bacteremia was observed.

Conclusions: Aggressive multifaceted horizontal infection control is an effective strategy for reducing the prevalence of methicillin-resistant S. aureus infection and eliminating methicillin-resistant S. aureus bacteremia in the ICU without the need for active surveillance and decontamination.

1Department of Surgery, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA.

2Division of Infectious and Geographic Diseases, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA.

3Department of Medicine and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA.

* See also p. 2292.

All work was performed at Tufts Medical Center, Boston, MA.

Dr. Doron is supported by Forest Laboratories. She lectured for Merck, Forest, and Optimer. Dr. Snydman consulted for Merck, Genzyme, Millenium, CSL Behring, and Genentech and lectured for Cubist, Optimer, and Merck. He has relationships with Microbiotix and Astra Zeneca. His institution received grant support from Cubist, Merck, Pfizer, Genentech, and Optimer. Dr. Noubary received support for article research from the National Institute of Health (NIH). His institution received grant support from the NIH. Dr. Nasraway is supported by Pfizer. He lectured for and received support for development of educational presentations from Pfizer. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Stanley A. Nasraway Jr, MD, FCCM, Department of Surgery, Tufts Medical Center, 800 Washington Street, Boston, MA 02111. E-mail: snasraway@tuftsmedicalcenter.org

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