Successful control of a Methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit: a retrospective, before-after studyReport as inadecuate




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BMC Infectious Diseases

, 13:440

Bacterial and fungal diseases

Abstract

BackgroundAim of this study was to provide a detailed description of a Methicillin-resistant Staphylococcus aureus MRSA outbreak management strategy in the neonatal intensive care unit of a university hospital.

MethodsThis was a retrospective -before-after- study, over two consecutive 18-month periods. The outbreak management strategy was performed by a multidisciplinary team and included: extensive healthcare workers HCW involvement, education, continuous hand-hygiene training and active MRSA colonization surveillance. The actions implemented were identified based on an anonymous, voluntary, reporting system, carried out among all the HCW, and regular audit and feedback were provided to the nursing staff.

The main measured outcome was the rate of MRSA infections before and after the implementation of the outbreak management strategy. Piecewise linear Poisson regression was performed and the model adjusted for confounding variables. The secondary outcome was the rate of laboratory-confirmed bloodstream infections before and after the outbreak management strategy. The rates of MRSA colonization, implementation of proposed actions, observed compliance for hand-hygiene and insertion-care of central lines were also recorded during the second period.

Results1015 newborns were included. The rate of MRSA infections throughout the two periods fell from 3.5 to 0.7 cases per 1000 patient-days p=0.0005. The piecewise Poisson regression analysis adjusted for confounding variables showed a significant decrease in the MRSA infection rate after the outbreak management strategy p=0.046. A significant decrease in positive laboratory confirmed blood cultures was observed over the two periods 160 vs 83; p<0.0001. A significant decline in the MRSA colonization rate occurred over the second period p=0.001; 93% of the proposed actions were implemented. The compliance rate for hand-hygiene and insertion-care of central lines was respectively 95.9% and 62%.

ConclusionsThe implementation of multiple, simultaneous, evidence-based management strategies is effective for controlling nosocomial infections. Outbreak management strategies may benefit from tools improving the communication between the institutional and scientific leadership and the ground-level staff. These measures can help to identify individualized solutions addressing specific unit needs.

KeywordsQuality-improvement Practices Newborn Hospital-acquired infection Community Endemic Voice, Bundle AbbreviationsCDCCenter from disease control

CVLCentral venous lines

HAIHospital-acquired infection

HCWHealthcare workers

MRSAMethicillin-resistant Staphylococcus aureus

MVMechanical ventilation

NICUNeonatal intensive care unit

PICUPaediatric intensive care unit

QCNsQuality control nurses.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-13-440 contains supplementary material, which is available to authorized users.

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Author: Silvia Iacobelli - Benoit Colomb - Francesco Bonsante - Karine Astruc - Cyril Ferdynus - Marie-France Bouthet - Catherine N

Source: https://link.springer.com/



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