Controlling MRSA in the healthcare setting An achievable goal?

Controlling MRSA in the healthcare setting An achievable goal?

Overview of presentation Why do we need to control MRSA? Approaches to controlling MRSA Prevention of transmission of MRSA Prevention of MRSA infection in patients who are already colonised MRSA detection methods Conclusions

Superbug putting off patients Sep 16 2004 Anger over killer bugs MRSA Jul 26 2004 MRSA victims tell of horror Aug 12 2004 Hospital bug fury Sep 3 2004

The reality MRSA Meticillin Resistant Staph. aureus MRSA infections are not untreatable MRSA is (generally) no more virulent than other strains of Staph. aureus

Why try to control MRSA? MRSA occurs as an additional pathogen Hospitals with high rates of MRSA will have higher rates of healthcare-associated infection MRSA may be especially likely to spread MRSA is expensive & inconvenient to treat and is becoming increasingly antibiotic-resistant Control measures can have an impact Costs of not controlling MRSA probably high Patient/public/political concern

% MRSA: the current position UK: % BC isolates of S. aureus that w ere MRSA 50 40 30 20 10 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

MRSA What are we doing about it in the UK? Department of Health target to halve the number of MRSA bacteraemias between 2004 & 2008 Documents Winning Ways, Saving Lives, etc. Campaigns NPSA Cleanyourhands campaign National cleaning services contract Conferences MRSA Learning from the Best conference Central performance management of hospitals

Bloodborne MRSA infection rates to be halved by 2008 - Reid X

Controlling MRSA in the healthcare setting An achievable goal?

Controlling MRSA Patient Infection control interventions Does not have MRSA Has MRSA No risk Risk of serious infection (including bacteraemia) Risk of transmission to others Clinical interventions to minimise risk

Controlling MRSA Two aspects: Preventing MRSA transmission Preventing MRSA infection in colonised patients Growing recognition that control of MRSA requires a systematic approach This in turn requires some knowledge of the local pattern of MRSA transmission & infection

Preventing MRSA transmission The Birmingham Children s Hospital experience Cases of MRSA acquired at BCH 35 30 25 20 15 10 5 0 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07

Orthopaedics Plastics/Burns Gen surgery Neurosurg Cardiac Gen paeds Haem/Onc Hepatology Respiratory Other surg Other medical Acquisition of MRSA in in-patients according to specialty. 90 80 70 60 50 40 30 20 10 0

Preventing MRSA transmission Routes of transmission MRSA +ve patient High prevalence hospitals Environment Vulnerable patient MRSA +ve Parent/ partner Low prevalence hospitals MRSA +ve Staff member?importance

Preventing MRSA transmission Infection control interventions Interventions proven to be of benefit Search & destroy strategy Detection of cases Isolation of cases Interventions of less certain benefit Hand hygiene Decolonisation treatment of carriers Measures to reduce risk of airborne spread

Reducing airborne spread of MRSA Bioquell unit (H 2 O 2 fumigation) Aircleanse unit (ozone-generating)

Preventing MRSA infection The Birmingham Children s Hospital experience MRSA: all cases & bloodstream infections 35 30 25 20 15 Cases BSI 10 5 0 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07

Preventing MRSA infection Screening may be necessary to detect colonisation Antimicrobial prophylaxis Use of antiseptics & other general hygiene measures Minimise use of invasive devices & ensure good technique?decolonisation therapy

Controlling MRSA Detection of cases Screening approaches Culture-based screening Takes days Real-time PCR Takes hours Becoming less complex Expensive Smartcycler GenExpert

Who to screen? Controlling MRSA Detection of cases Previously MRSA-positive Recent hospital in-patient care Lives in same household as someone who has MRSA Healthcare worker But an increasing proportion of people found to be carrying MRSA have no recognisable risk factors

Conclusions Prevention of transmission of MRSA REQUIRES: Identification & isolation of colonised patients Good standards of environmental cleanliness MAY REQUIRE: Identification & treatment of colonised staff Further measures to reduce environmental contamination

Conclusions Prevention of invasive infections in colonised patients REQUIRES: Focus on likely portals of entry of infection Surgery Indwelling medical devices MAY REQUIRE: Identification of colonised patients