Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
Identifieur interne : 004778 ( Main/Exploration ); précédent : 004777; suivant : 004779Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
Auteurs : Andie S. Lee [Suisse, Australie] ; Ben S. Cooper [Thaïlande, Royaume-Uni] ; Surbhi Malhotra-Kumar [Belgique] ; Annie Chalfine [France] ; George L. Daikos [Grèce] ; Carolina Fankhauser [Suisse] ; Biljana Carevic [Serbie] ; Sebastian Lemmen [Allemagne] ; José Antonio Martínez [Espagne] ; Cristina Masuet-Aumatell [Espagne] ; Angelo Pan [Italie] ; Gabby Phillips ; Bina Rubinovitch [Israël] ; Herman Goossens [Belgique] ; Christian Brun-Buisson [France] ; Stephan Harbarth [Suisse]Source :
- BMJ Open [ 2044-6055 ] ; 2013.
Abstract
To compare the effect of two strategies (enhanced hand hygiene vs meticillin-resistant
Prospective, controlled, interventional cohort study, with 6-month baseline, 12-month intervention and 6-month washout phases.
33 surgical wards of 10 hospitals in nine countries in Europe and Israel.
All patients admitted to the enrolled wards for more than 24 h.
The two strategies compared were (1) enhanced hand hygiene promotion and (2) universal MRSA screening with contact precautions and decolonisation (intranasal mupirocin and chlorhexidine bathing) of MRSA carriers. Four hospitals were assigned to each intervention and two hospitals combined both strategies, using targeted MRSA screening.
Monthly rates of MRSA clinical cultures per 100 susceptible patients (primary outcome) and MRSA infections per 100 admissions (secondary outcome). Planned subgroup analysis for clean surgery wards was performed.
After adjusting for clustering and potential confounders, neither strategy when used alone was associated with significant changes in MRSA rates. Combining both strategies was associated with a reduction in the rate of MRSA clinical cultures of 12% per month (adjusted incidence rate ratios (aIRR) 0.88, 95% CI 0.79 to 0.98). In clean surgery wards, strategy 2 (MRSA screening, contact precautions and decolonisation) was associated with decreasing rates of MRSA clinical cultures (15% monthly decrease, aIRR 0.85, 95% CI 0.74 to 0.97) and MRSA infections (17% monthly decrease, aIRR 0.83, 95% CI 0.69 to 0.99).
In surgical wards with relatively low MRSA prevalence, a combination of enhanced standard and MRSA-specific infection control approaches was required to reduce MRSA rates. Implementation of single interventions was not effective, except in clean surgery wards where MRSA screening coupled with contact precautions and decolonisation was associated with significant reductions in MRSA clinical culture and infection rates.
clinicaltrials.gov identifier: NCT00685867
Url:
DOI: 10.1136/bmjopen-2013-003126
PubMed: 24056477
PubMed Central: 3780302
Affiliations:
- Allemagne, Australie, Belgique, Espagne, France, Grèce, Israël, Italie, Royaume-Uni, Serbie, Suisse, Thaïlande
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Lee</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Infection Control Program</addr-line>,<institution>University of Geneva Hospitals and Faculty of Medicine</institution>,<addr-line>Geneva</addr-line>,<country>Switzerland</country></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Departments of Infectious Diseases and Microbiology</addr-line>,<institution>Royal Prince Alfred Hospital</institution>,<addr-line>Sydney</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Cooper, Ben S" sort="Cooper, Ben S" uniqKey="Cooper B" first="Ben S" last="Cooper">Ben S. 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Antwerp</institution>,<addr-line>Wilrijk</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Brun Buisson, Christian" sort="Brun Buisson, Christian" uniqKey="Brun Buisson C" first="Christian" last="Brun-Buisson">Christian Brun-Buisson</name><affiliation wicri:level="1"><nlm:aff id="af15"><addr-line>Inserm U 657, Institut Pasteur, Paris</addr-line>;<institution>Department of Intensive Care, Hopital Henri Mondor, Universite Paris-Est Creteil</institution>,<addr-line>Creteil</addr-line>,<country>France</country></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Harbarth, Stephan" sort="Harbarth, Stephan" uniqKey="Harbarth S" first="Stephan" last="Harbarth">Stephan Harbarth</name><affiliation wicri:level="1"><nlm:aff 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Lee</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Infection Control Program</addr-line>,<institution>University of Geneva Hospitals and Faculty of Medicine</institution>,<addr-line>Geneva</addr-line>,<country>Switzerland</country></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Departments of Infectious Diseases and Microbiology</addr-line>,<institution>Royal Prince Alfred Hospital</institution>,<addr-line>Sydney</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Cooper, Ben S" sort="Cooper, Ben S" uniqKey="Cooper B" first="Ben S" last="Cooper">Ben S. Cooper</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine</addr-line>,<institution>Mahidol University</institution>,<addr-line>Bangkok</addr-line>,<country>Thailand</country></nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af4"><addr-line>Nuffield Department of Clinical Medicine</addr-line>,<institution>Centre for Clinical Vaccinology and Tropical Medicine</institution>,<institution>University of Oxford</institution>,<addr-line>Oxford</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Malhotra Kumar, Surbhi" sort="Malhotra Kumar, Surbhi" uniqKey="Malhotra Kumar S" first="Surbhi" last="Malhotra-Kumar">Surbhi Malhotra-Kumar</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Department of Medical Microbiology</addr-line>,<institution>Vaccine and Infectious Disease Institute</institution>,<institution>University of Antwerp</institution>,<addr-line>Wilrijk</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Chalfine, Annie" sort="Chalfine, Annie" uniqKey="Chalfine A" first="Annie" last="Chalfine">Annie Chalfine</name><affiliation wicri:level="1"><nlm:aff id="af6"><addr-line>Infection Control Unit</addr-line>,<institution>Groupe Hospitalier Paris Saint-Joseph</institution>,<addr-line>Paris</addr-line>,<country>France</country></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Daikos, George L" sort="Daikos, George L" uniqKey="Daikos G" first="George L" last="Daikos">George L. Daikos</name><affiliation wicri:level="1"><nlm:aff id="af7"><addr-line>First Department of Propaedeutic Medicine</addr-line>,<institution>Laiko General Hospital</institution>,<addr-line>Athens</addr-line>,<country>Greece</country></nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Fankhauser, Carolina" sort="Fankhauser, Carolina" uniqKey="Fankhauser C" first="Carolina" last="Fankhauser">Carolina Fankhauser</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Infection Control Program</addr-line>,<institution>University of Geneva Hospitals and Faculty of Medicine</institution>,<addr-line>Geneva</addr-line>,<country>Switzerland</country></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Carevic, Biljana" sort="Carevic, Biljana" uniqKey="Carevic B" first="Biljana" last="Carevic">Biljana Carevic</name><affiliation wicri:level="1"><nlm:aff id="af8"><addr-line>Department of Hospital Epidemiology</addr-line>,<institution>Clinical Center of Serbia</institution>,<addr-line>Belgrade</addr-line>,<country>Serbia</country></nlm:aff><country xml:lang="fr">Serbie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lemmen, Sebastian" sort="Lemmen, Sebastian" uniqKey="Lemmen S" first="Sebastian" last="Lemmen">Sebastian Lemmen</name><affiliation wicri:level="1"><nlm:aff id="af9"><addr-line>Department of Infection Control and Infectious Diseases</addr-line>,<institution>Universitätsklinikum Aachen</institution>,<addr-line>Aachen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Martinez, Jose Antonio" sort="Martinez, Jose Antonio" uniqKey="Martinez J" first="José Antonio" last="Martínez">José Antonio Martínez</name><affiliation wicri:level="1"><nlm:aff id="af10"><addr-line>Service of Infectious Diseases</addr-line>,<institution>Hospital Clínic de Barcelona</institution>,<addr-line>Barcelona</addr-line>,<country>Spain</country></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Masuet Aumatell, Cristina" sort="Masuet Aumatell, Cristina" uniqKey="Masuet Aumatell C" first="Cristina" last="Masuet-Aumatell">Cristina Masuet-Aumatell</name><affiliation wicri:level="1"><nlm:aff id="af11"><addr-line>Preventive Medicine Department and Faculty of Medicine</addr-line>,<institution>Bellvitge Biomedical Research Institute (IDIBELL), University Hospital of Bellvitge, L'Hospitalet de Llobregat</institution>,<addr-line>Barcelona</addr-line>,<country>Spain</country></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Pan, Angelo" sort="Pan, Angelo" uniqKey="Pan A" first="Angelo" last="Pan">Angelo Pan</name><affiliation wicri:level="1"><nlm:aff id="af12"><addr-line>Infectious and Tropical Diseases Unit</addr-line>,<institution>Istituti Ospitalieri di Cremona</institution>,<addr-line>Cremona</addr-line>,<country>Italy</country></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Phillips, Gabby" sort="Phillips, Gabby" uniqKey="Phillips G" first="Gabby" last="Phillips">Gabby Phillips</name><affiliation><nlm:aff id="af13"><addr-line>Infection Control Department</addr-line>,<institution>Ninewells Hospital</institution>,<addr-line>Dundee</addr-line>,<country>Scotland</country></nlm:aff><wicri:noCountry code="nlm country">Scotland</wicri:noCountry></affiliation></author><author><name sortKey="Rubinovitch, Bina" sort="Rubinovitch, Bina" uniqKey="Rubinovitch B" first="Bina" last="Rubinovitch">Bina Rubinovitch</name><affiliation wicri:level="1"><nlm:aff id="af14"><addr-line>Unit of Infection Control</addr-line>,<institution>Rabin Medical Center, Beilinson Hospital</institution>,<addr-line>Petah-Tikva</addr-line>,<country>Israel</country></nlm:aff><country xml:lang="fr">Israël</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Goossens, Herman" sort="Goossens, Herman" uniqKey="Goossens H" first="Herman" last="Goossens">Herman Goossens</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Department of Medical Microbiology</addr-line>,<institution>Vaccine and Infectious Disease Institute</institution>,<institution>University of Antwerp</institution>,<addr-line>Wilrijk</addr-line>,<country>Belgium</country></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Brun Buisson, Christian" sort="Brun Buisson, Christian" uniqKey="Brun Buisson C" first="Christian" last="Brun-Buisson">Christian Brun-Buisson</name><affiliation wicri:level="1"><nlm:aff id="af15"><addr-line>Inserm U 657, Institut Pasteur, Paris</addr-line>;<institution>Department of Intensive Care, Hopital Henri Mondor, Universite Paris-Est Creteil</institution>,<addr-line>Creteil</addr-line>,<country>France</country></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Harbarth, Stephan" sort="Harbarth, Stephan" uniqKey="Harbarth S" first="Stephan" last="Harbarth">Stephan Harbarth</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Infection Control Program</addr-line>,<institution>University of Geneva Hospitals and Faculty of Medicine</institution>,<addr-line>Geneva</addr-line>,<country>Switzerland</country></nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To compare the effect of two strategies (enhanced hand hygiene vs meticillin-resistant <italic>Staphylococcus aureus</italic> (MRSA) screening and decolonisation) alone and in combination on MRSA rates in surgical wards.</p></sec><sec><title>Design</title><p>Prospective, controlled, interventional cohort study, with 6-month baseline, 12-month intervention and 6-month washout phases.</p></sec><sec><title>Setting</title><p>33 surgical wards of 10 hospitals in nine countries in Europe and Israel.</p></sec><sec><title>Participants</title><p>All patients admitted to the enrolled wards for more than 24 h.</p></sec><sec><title>Interventions</title><p>The two strategies compared were (1) enhanced hand hygiene promotion and (2) universal MRSA screening with contact precautions and decolonisation (intranasal mupirocin and chlorhexidine bathing) of MRSA carriers. Four hospitals were assigned to each intervention and two hospitals combined both strategies, using targeted MRSA screening.</p></sec><sec><title>Outcome measures</title><p>Monthly rates of MRSA clinical cultures per 100 susceptible patients (primary outcome) and MRSA infections per 100 admissions (secondary outcome). Planned subgroup analysis for clean surgery wards was performed.</p></sec><sec><title>Results</title><p>After adjusting for clustering and potential confounders, neither strategy when used alone was associated with significant changes in MRSA rates. Combining both strategies was associated with a reduction in the rate of MRSA clinical cultures of 12% per month (adjusted incidence rate ratios (aIRR) 0.88, 95% CI 0.79 to 0.98). In clean surgery wards, strategy 2 (MRSA screening, contact precautions and decolonisation) was associated with decreasing rates of MRSA clinical cultures (15% monthly decrease, aIRR 0.85, 95% CI 0.74 to 0.97) and MRSA infections (17% monthly decrease, aIRR 0.83, 95% CI 0.69 to 0.99).</p></sec><sec><title>Conclusions</title><p>In surgical wards with relatively low MRSA prevalence, a combination of enhanced standard and MRSA-specific infection control approaches was required to reduce MRSA rates. Implementation of single interventions was not effective, except in clean surgery wards where MRSA screening coupled with contact precautions and decolonisation was associated with significant reductions in MRSA clinical culture and infection rates.</p></sec><sec><title>Trial registration</title><p>clinicaltrials.gov identifier: NCT00685867</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Cosgrove, Se" uniqKey="Cosgrove S">SE Cosgrove</name></author><author><name sortKey="Qi, Y" uniqKey="Qi Y">Y Qi</name></author><author><name sortKey="Kaye, Ks" uniqKey="Kaye K">KS Kaye</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weber, Sg" uniqKey="Weber S">SG Weber</name></author><author><name sortKey="Huang, Ss" uniqKey="Huang S">SS Huang</name></author><author><name sortKey="Oriola, S" uniqKey="Oriola S">S 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Lee</name></noRegion><name sortKey="Fankhauser, Carolina" sort="Fankhauser, Carolina" uniqKey="Fankhauser C" first="Carolina" last="Fankhauser">Carolina Fankhauser</name><name sortKey="Harbarth, Stephan" sort="Harbarth, Stephan" uniqKey="Harbarth S" first="Stephan" last="Harbarth">Stephan Harbarth</name></country><country name="Australie"><noRegion><name sortKey="Lee, Andie S" sort="Lee, Andie S" uniqKey="Lee A" first="Andie S" last="Lee">Andie S. Lee</name></noRegion></country><country name="Thaïlande"><noRegion><name sortKey="Cooper, Ben S" sort="Cooper, Ben S" uniqKey="Cooper B" first="Ben S" last="Cooper">Ben S. Cooper</name></noRegion></country><country name="Royaume-Uni"><noRegion><name sortKey="Cooper, Ben S" sort="Cooper, Ben S" uniqKey="Cooper B" first="Ben S" last="Cooper">Ben S. Cooper</name></noRegion></country><country name="Belgique"><noRegion><name sortKey="Malhotra Kumar, Surbhi" sort="Malhotra Kumar, Surbhi" uniqKey="Malhotra Kumar S" first="Surbhi" last="Malhotra-Kumar">Surbhi Malhotra-Kumar</name></noRegion><name sortKey="Goossens, Herman" sort="Goossens, Herman" uniqKey="Goossens H" first="Herman" last="Goossens">Herman Goossens</name></country><country name="France"><noRegion><name sortKey="Chalfine, Annie" sort="Chalfine, Annie" uniqKey="Chalfine A" first="Annie" last="Chalfine">Annie Chalfine</name></noRegion><name sortKey="Brun Buisson, Christian" sort="Brun Buisson, Christian" uniqKey="Brun Buisson C" first="Christian" last="Brun-Buisson">Christian Brun-Buisson</name></country><country name="Grèce"><noRegion><name sortKey="Daikos, George L" sort="Daikos, George L" uniqKey="Daikos G" first="George L" last="Daikos">George L. Daikos</name></noRegion></country><country name="Serbie"><noRegion><name sortKey="Carevic, Biljana" sort="Carevic, Biljana" uniqKey="Carevic B" first="Biljana" last="Carevic">Biljana Carevic</name></noRegion></country><country name="Allemagne"><noRegion><name sortKey="Lemmen, Sebastian" sort="Lemmen, Sebastian" uniqKey="Lemmen S" first="Sebastian" last="Lemmen">Sebastian Lemmen</name></noRegion></country><country name="Espagne"><noRegion><name sortKey="Martinez, Jose Antonio" sort="Martinez, Jose Antonio" uniqKey="Martinez J" first="José Antonio" last="Martínez">José Antonio Martínez</name></noRegion><name sortKey="Masuet Aumatell, Cristina" sort="Masuet Aumatell, Cristina" uniqKey="Masuet Aumatell C" first="Cristina" last="Masuet-Aumatell">Cristina Masuet-Aumatell</name></country><country name="Italie"><noRegion><name sortKey="Pan, Angelo" sort="Pan, Angelo" uniqKey="Pan A" first="Angelo" last="Pan">Angelo Pan</name></noRegion></country><country name="Israël"><noRegion><name sortKey="Rubinovitch, Bina" sort="Rubinovitch, Bina" uniqKey="Rubinovitch B" first="Bina" last="Rubinovitch">Bina Rubinovitch</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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