The role of general quality improvement measures in decreasing the burden of endemic MRSA in a medical-surgical intensive care unit

Michelle R. Ananda-Rajah, Emma S. Mcbryde, Kirsty L. Buising, Leanne Redl, Christopher Macisaac, John F Cade, Caroline Marshall

Research output: Contribution to journalArticleResearchpeer-review

8 Citations (Scopus)

Abstract

Purpose: To determine whether any of several quality improvement interventions with none specifically targeting methicillinresistant Staphylococcus aureus (MRSA) were associated with a decline in endemic MRSA prevalence in an intensive care unit (ICU) where active screening and contact isolation precautions for known MRSA colonised patients are not practised. Setting: Medical-surgical ICU with 2,000 admissions/year. Design: 8.5- year retrospective time-series analysis. Interventions: ICU re-location, antibiotic stewardship utilising computerised decision-support and infectious-diseases physician rounds, dedicated ICU infection control practitioners, alcohol-based hand rub solution (ABHRS). Method: Regression modelling was used to evaluate trends in S. aureus prevalence density (monthly clinical isolates per 1,000 patient-days), antibiotic consumption, infection control consumables, ABHRS and their temporal relationship with MRSA prevalence. Results: Methicillinresistant S. aureus prevalence density decreased by 83% [95% confidence interval (CI) -68% to -91%, p<0.001]. Rates of MRSA bacteraemia decreased 89% (95% CI -79% to -94%, p = 0.001) with no statistically significant change in methicillin-sensitive S. aureus bacteraemia. Hospital MRSA prevalence density decreased 17% (95% CI -5% to -27%, p = 0.005), suggesting that ICU was not shifting MRSA elsewhere. In ICU, broad-spectrum antibiotic use decreased by 26% (95% CI -12% to -38%, p = 0.008), coinciding with a decrease in MRSA, but time-series analysis did not show a significant association. On multivariate analysis, only ABHRS was significantly associated with a decrease in MRSA, but it was formally introduced late in the study period when MRSA was already in decline. Conclusion: General quality improvement measures were associated with a decrease in endemic MRSA in a high-risk setting without use of resource-intensive active surveillance and isolation practices.

Original languageEnglish
Pages (from-to)1890-1898
Number of pages9
JournalIntensive Care Medicine
Volume36
Issue number11
DOIs
Publication statusPublished - Nov 2010

Keywords

  • Infection control
  • Intensive care unit
  • Methicillin-resistant staphylococcus aureus
  • Nosocomial infections

Cite this

Ananda-Rajah, Michelle R. ; Mcbryde, Emma S. ; Buising, Kirsty L. ; Redl, Leanne ; Macisaac, Christopher ; Cade, John F ; Marshall, Caroline. / The role of general quality improvement measures in decreasing the burden of endemic MRSA in a medical-surgical intensive care unit. In: Intensive Care Medicine. 2010 ; Vol. 36, No. 11. pp. 1890-1898.
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abstract = "Purpose: To determine whether any of several quality improvement interventions with none specifically targeting methicillinresistant Staphylococcus aureus (MRSA) were associated with a decline in endemic MRSA prevalence in an intensive care unit (ICU) where active screening and contact isolation precautions for known MRSA colonised patients are not practised. Setting: Medical-surgical ICU with 2,000 admissions/year. Design: 8.5- year retrospective time-series analysis. Interventions: ICU re-location, antibiotic stewardship utilising computerised decision-support and infectious-diseases physician rounds, dedicated ICU infection control practitioners, alcohol-based hand rub solution (ABHRS). Method: Regression modelling was used to evaluate trends in S. aureus prevalence density (monthly clinical isolates per 1,000 patient-days), antibiotic consumption, infection control consumables, ABHRS and their temporal relationship with MRSA prevalence. Results: Methicillinresistant S. aureus prevalence density decreased by 83{\%} [95{\%} confidence interval (CI) -68{\%} to -91{\%}, p<0.001]. Rates of MRSA bacteraemia decreased 89{\%} (95{\%} CI -79{\%} to -94{\%}, p = 0.001) with no statistically significant change in methicillin-sensitive S. aureus bacteraemia. Hospital MRSA prevalence density decreased 17{\%} (95{\%} CI -5{\%} to -27{\%}, p = 0.005), suggesting that ICU was not shifting MRSA elsewhere. In ICU, broad-spectrum antibiotic use decreased by 26{\%} (95{\%} CI -12{\%} to -38{\%}, p = 0.008), coinciding with a decrease in MRSA, but time-series analysis did not show a significant association. On multivariate analysis, only ABHRS was significantly associated with a decrease in MRSA, but it was formally introduced late in the study period when MRSA was already in decline. Conclusion: General quality improvement measures were associated with a decrease in endemic MRSA in a high-risk setting without use of resource-intensive active surveillance and isolation practices.",
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The role of general quality improvement measures in decreasing the burden of endemic MRSA in a medical-surgical intensive care unit. / Ananda-Rajah, Michelle R.; Mcbryde, Emma S.; Buising, Kirsty L.; Redl, Leanne; Macisaac, Christopher; Cade, John F; Marshall, Caroline.

In: Intensive Care Medicine, Vol. 36, No. 11, 11.2010, p. 1890-1898.

Research output: Contribution to journalArticleResearchpeer-review

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