The value of the infection prevention and control nurse led MRSA ward round

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Abstract

Meticillin-resistant S. aureus (MRSA) is prevalent in most parts of the world. The study took place at Queen Elizabeth Hospital Birmingham (QEHB) a UK tertiary referral hospital. At QEHB innovative nurse led daily ward rounds for patients that acquire hospital acquired MRSA during their hospital stay are undertaken. The aim is to optimise care delivered for these patients whilst at QEHB, thereby reducing the risk of infection in patients with healthcare-acquired MRSA. A segmented Poisson regression model suggests that the MRSA bacteraemia rate was affected where an 88.94% reduction ( p = 0.0561) in bacteraemias was seen by the introduction of these ward rounds. We describe a nurse led MRSA ward round which was associated with a lower rate of MRSA bacteraemias.

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Modelling interrupted time series to evaluate prevention and control of infection in healthcare.

J Jernigan, D Kleinbaum, Janet W. Rich-Edwards … (2012)

The most common methods for evaluating interventions to reduce the rate of new Staphylococcus aureus (MRSA) infections in hospitals use segmented regression or interrupted time-series analysis. We describe approaches to evaluating interventions introduced in different healthcare units at different times. We compare fitting a segmented Poisson regression in each hospital unit with pooling the individual estimates by inverse variance. An extension of this approach to accommodate potential heterogeneity allows estimates to be calculated from a single statistical model: a 'stacked' model. It can be used to ascertain whether transmission rates before the intervention have the same slope in all units, whether the immediate impact of the intervention is the same in all units, and whether transmission rates have the same slope after the intervention. The methods are illustrated by analyses of data from a study at a Veterans Affairs hospital. Both approaches yielded consistent results. Where feasible, a model adjusting for the unit effect should be fitted, or if there is heterogeneity, an analysis incorporating a random effect for units may be appropriate.

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Zero tolerance for healthcare-associated MRSA bacteraemia: is it realistic?

M. Török, Simon R. Harris, Edward J. P. Cartwright … (2014)

Background The term ‘zero tolerance’ has recently been applied to healthcare-associated infections, implying that such events are always preventable. This may not be the case for healthcare-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Methods We combined information from an epidemiological investigation and bacterial whole-genome sequencing to evaluate a cluster of five MRSA bacteraemia episodes in four patients in a specialist hepatology unit. Results The five MRSA bacteraemia isolates were highly related by multilocus sequence type (ST) (four isolates were ST22 and one isolate was a single-locus variant, ST2046). Whole-genome sequencing demonstrated unequivocally that the bacteraemia cases were unrelated. Placing the MRSA bacteraemia isolates within a local and global phylogenetic tree of MRSA ST22 genomes demonstrated that the five bacteraemia isolates were highly diverse. This was consistent with the acquisition and importation of MRSA from the wider referral network. Analysis of MRSA carriage and disease in patients within the hepatology service demonstrated a higher risk of both initial MRSA acquisition compared with the nephrology service and a higher risk of progression from MRSA carriage to bacteraemia, compared with patients in nephrology or geriatric services. A root cause analysis failed to reveal any mechanism by which three of five MRSA bacteraemia episodes could have been prevented. Conclusions This study illustrates the complex nature of MRSA carriage and bacteraemia in patients in a specialized hepatology unit. Despite numerous ongoing interventions to prevent MRSA bacteraemia in healthcare settings, these are unlikely to result in a zero incidence in referral centres that treat highly complex patients.

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MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers.

Faiza Siddiqui, M C Roghmann, K Plaisance … (2001)

A cohort study of patients with chronic ulcers was performed to estimate the risk of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in a population colonized with MRSA. During a five-year period (January 1990-May 1995), 911 patients with chronic ulcers (CU), as determined by ICD9-CM code search, were admitted to an acute care hospital. Sixty percent (545/911) of these patients with CU had their CU cultured to detect MRSA and 30% (166/545) of these were colonized with MRSA. Among patients with surveillance cultures, those with MRSA colonization had significantly more days of hospitalization and were also more likely to have a central venous catheter during hospitalization compared with patients without MRSA colonization. MRSA bacteraemia occurred in 4% (36/911) of CU patients during the study period and in 6% (32/545) of cultured CU patients. Among the 545 patients who had surveillance cultures, the risk ratio for MRSA bacteraemia when there was MRSA colonization of their chronic ulcer was 16 (95% CI 6-45). Among patients with MRSA colonization, central venous catheter use was the only significant risk factor for MRSA bacteraemia. In 16 of the 28 patients with MRSA bacteraemia and MRSA colonization, the MRSA colonization was identified more than seven days before the bacteraemia. This cohort study identifies MRSA colonized CU patients in an acute care setting as a high-risk population for MRSA bacteraemia. Copyright 2001 The Hospital Infection Society.

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Author and article information

Contributors

Mark I. Garvey:

ORCID: http://orcid.org/0000-0001-7324-5306

0121 371 3787 , mark.garvey@uhb.nhs.uk , m.i.garvey@bham.ac.uk

Craig W. Bradley: craig.bradley@nhs.net

Martyn A. C. Wilkinson: martyn.wilkinson@uhb.nhs.uk

Kerry L. Holden: kerry.holden2@nhs.net

Victoria Clewer: victoria.clewer@uhb.nhs.uk

Elisabeth Holden: Elisabeth.holden@uhb.nhs.uk

Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central (London )

ISSN (Electronic): 2047-2994

Publication date (Electronic): 12 March 2019

Publication date PMC-release: 12 March 2019

Publication date Collection: 2019

Volume: 8

Electronic Location Identifier: 53

Affiliations

[1 ]ISNI 0000 0001 2177 007X, GRID grid.415490.d, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, ; Edgbaston, Birmingham, B15 2WB UK

[2 ]ISNI 0000 0004 1936 7486, GRID grid.6572.6, Institute of Microbiology and Infection, , The University of Birmingham, ; Edgbaston, Birmingham, UK

[3 ]ISNI 0000 0001 0489 6543, GRID grid.413144.7, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, ; Gloucester, GL1 3NN UK

Author information

Mark I. Garvey http://orcid.org/0000-0001-7324-5306

Article

Publisher ID: 506

DOI: 10.1186/s13756-019-0506-6

PMC ID: 6417022

SO-VID: eb090c6d-e926-41fa-8d92-7988b5069343

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.