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. 2014 Jun 19;9(6):e100493.
doi: 10.1371/journal.pone.0100493. eCollection 2014.

Minimal Intervention for Controlling Nosocomial Transmission of Methicillin-Resistant Staphylococcus Aureus in Resource Limited Setting With High Endemicity

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Free PMC article

Minimal Intervention for Controlling Nosocomial Transmission of Methicillin-Resistant Staphylococcus Aureus in Resource Limited Setting With High Endemicity

Vincent Chi-Chung Cheng et al. PLoS One. .
Free PMC article

Abstract

Objective: To control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in resource-limited healthcare setting with high endemicity.

Methods: Three phases of infection control interventions were implemented in a University-affiliated hospital between 1-January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per-1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model). Usage density of broad-spectrum antibiotics was monitored.

Results: During the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3%) were hospital-acquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001), 30.4% (p<0.001), and 19.6% (p = 0.040), while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001), 24.1% (p<0.001), and 21.9% (p = 0.041) respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1) to 168.99 per 1000 patient-days (phase 3).

Conclusions: Nosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing for MRSA-positive despite an increasing consumption of broad-spectrum antibiotics.

Conflict of interest statement

Competing Interests: The authors confirm that co-author Jonathan Hon-Kwan Chen is a PLOS ONE Editorial Board member. This does not alter their adherence to PLOS ONE Editorial policies and criteria.

Figures

Figure 1
Figure 1. Incidence rate of hospital-acquired MRSA per 1000 admissions in the three phases of intervention.
Figure 2
Figure 2. Incidence rate of hospital-acquired MRSA per 1000 patient-days in the three phases of intervention.
Figure 3
Figure 3. Incidence rate of hospital-acquired MRSA per 1000 MRSA-positive-days in three different phases of intervention.

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