Active Surveillance, Cleaning Cut Staph Infections in the Surgical ICU

Infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) is associated with significant morbidity and mortality. Researchers from Changi General Hospital in Singapore sought to study the impact of active surveillance cultures (ASC), environmental cleaning and decolonization regimen in reducing MRSA infections in a surgical intensive care unit (SICU). Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland June 29-July 2, 2011.

The study was conducted in the SICU where ASCs were performed from Sept. 20, 2010 to Feb 28, 2011 on all patients admitted/transferred in/transferred out of the SICU. ASC specimens consisted of swabs from anterior nares and axilla/groin. The swabs were inoculated onto chromogenic agar selective for MRSA (MRSASelect, Bio-Rad). MRSA positive patients were placed on contact precautions/isolation. Automatic hand sanitizers were installed in SICU to increase hand hygiene compliance. The decolonization regimen consisted of mupirocin ointment tds and daily Prontoderm (0.1% polyhexanide) for five days. Sureclean, an ionic silver disinfectant lasting 24 hours, was used for environmental disinfection.

Oh, et al. report that 453 patients were screened on entry/transfer in. Forty-five patients (9.9 percent) were detected to be MRSA colonized on entry; 214 patients were screened on transfer out/death; nine patients (4.2 percent) acquired MRSA on exit. There were 10 skin, 29 nasal and 15 skin/nasal carriers. There was an increase in overall hand hygiene compliance from 68.4 percent in September 2010 to 90.9 percent in Feb 2011. The incidence of MRSA Infection was reduced from 1.7/1,000 patient days (March to August 2010) to 0.9/1,000 patient days (September 2010 to February 2011).

Oh, et al. say they demonstrated a significant reduction of MRSA Infections in SICU with implementation of ASC.

Reference: Oh HM, Tan T-Y, Chua GH, Li J and Meng QS. The impact of active surveillance cultures in reducing methicillin-resistant Staphylococcus aureus infections in a surgical intensive care unit in Singapore. Presentation at the International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):P233doi:10.1186/1753-6561-5-S6-P233