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. 2013 Oct;85(2):141-8.
doi: 10.1016/j.jhin.2013.07.005. Epub 2013 Sep 5.

Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore

D Fisher  1 , P A Tambyah, R T P Lin, R Jureen, A R Cook, A Lim, B Ong, M Balm, T M Ng, L Y Hsu
Affiliations

Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore

D Fisher et al. J Hosp Infect. 2013 Oct.

Abstract

Background: Meticillin-resistant Staphylococcus aureus (MRSA) has been entrenched in Singapore hospitals since the 1980s, with an excess of 600 non-duplicate cases of infections (120 bacteraemia episodes) each year in our 995-bed university hospital. Approximately 5% of our hospital beds are used as isolation facilities.

Aim: To study the impact of an MRSA control bundle that was implemented via gradual geographic extension across hospital wards.

Methods: The bundle included active surveillance on admission and transfer/discharge to identify ward-based acquisition of MRSA, isolation and cohorting of MRSA-infected patients, enhanced hand hygiene initiatives, and publicly displayed feedback of MRSA acquisition and hand hygiene compliance rates. Implementation was between October 2006 and June 2010 in order to provide lead-time for the incremental development of infrastructural capacity, and to develop an ethic of infection prevention among staff. Results were analysed via interrupted time-series analysis.

Findings: MRSA infections fell midway through the implementation, with MRSA bacteraemia declining from 0.26 [95% confidence interval (CI): 0.18-0.34] cases per 1000 inpatient-days in the first quarter of 2004 to 0.11 (95% CI: 0.07-0.19) cases per 1000 inpatient-days in the first quarter of 2012. MRSA acquisition rates fell a year after the programme had been fully implemented, whereas hand hygiene compliance rose significantly from 47% (95% CI: 44-49) in the first quarter of 2009 to 69% (95% CI: 68-71) in the first quarter of 2012.

Conclusion: Successful staged implementation of an MRSA bundle in a hyper-endemic setting is sustainable and represents a model that may be adapted for similar settings.

Keywords: Active surveillance; Cohorting; Hand hygiene; Infection control; Meticillin-resistant Staphylococcus aureus; Time-series analysis.

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Figures

Figure 1
Figure 1
Time-scale of the roll-out of the meticillin-resistant Staphylococcus aureus (MRSA) bundle, showing the percentage of wards covered, as well as other interventions.
Figure 2
Figure 2
Outcome measures over time. (a) Incidence-density of meticillin-resistant Staphylococcus aureus (MRSA) cases per 1000 inpatient-days. (b) Proportion of patients with inpatient acquisition of MRSA. (c) Incidence-density of MRSA bacteraemia per 1000 inpatient-days. (d) Percentage of hand hygiene compliance according to the World Health Organization audit tool.
Figure 3
Figure 3
Trends of defined daily doses (DDD) per 1000 inpatient-days of major broad-spectrum antibiotics prescribed at our institution.
See this image and copyright information in PMC

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