Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
Comparison of strategies to reduce meticillin-resistant Staphylococcus aureus rates in surgical patients: a controlled multicentre intervention trial
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DOI：
10.1136/bmjopen-2013-003126
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发表时间：
2013-01-01
期刊：
影响因子：
2.9
通讯作者：
Harbarth, Stephan
中科院分区：
文献类型：
--
作者：
Lee, Andie S.;Cooper, Ben S.;Harbarth, Stephan
目的：比较两种策略(加强手卫生与耐甲氧西林金黄色葡萄球菌(MRSA)筛查和去克隆)单独和联合应用对外科病房MRSA感染率的影响。设计：前瞻性、对照、干预性队列研究，包括6个月基线、12个月干预和6个月冲洗阶段。研究对象：来自欧洲和以色列9个国家10家医院的33个外科病房。参与者：所有在登记病房住院超过24小时的患者。干预：(1)加强手卫生宣传和(2)对MRSA携带者进行全面的MRSA筛查和去结肠化(经鼻注射甲氧西林和洗必泰洗浴)。四家医院被分配到每种干预措施，两家医院结合了两种策略，使用有针对性的MRSA筛查。结果衡量标准：每100名易感患者的MRSA临床培养月率(主要结果)和每100名住院患者的MRSA感染率(次要结果)。对清洁外科病房进行了计划亚组分析。结果：在调整了分组和潜在混杂因素后，单独使用这两种策略都与MRSA率的显著变化无关。这两种策略的结合与每月12%的MRSA临床培养率降低相关(调整后的发病率比(AIRR)为0.88，95%CI为0.79至0.98)。在清洁外科病房，策略2(MRSA筛查、接触预防和去克隆)与MRSA临床培养减少(每月减少15%，aIRR为0.85，95%CI为0.74至0.97)和MRSA感染率(每月减少17%，aIRR为0.83，95%CI为0.69至0.99)相关。结论：在MRSA感染率相对较低的外科病房，需要加强标准和针对MRSA的感染控制相结合的方法来降低MRSA感染率。单一干预措施的实施不是有效的，除非在清洁的外科病房，在那里MRSA筛查加上接触预防和去克隆与MRSA临床培养和感染率的显著降低有关。
Objective: To compare the effect of two strategies (enhanced hand hygiene vs meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonisation) alone and in combination on MRSA rates in surgical wards.Design: Prospective, controlled, interventional cohort study, with 6-month baseline, 12-month intervention and 6-month washout phases.Setting: 33 surgical wards of 10 hospitals in nine countries in Europe and Israel.Participants: All patients admitted to the enrolled wards for more than 24 h.Interventions: 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.Outcome measures: 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.Results: 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% Cl 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% Cl 0.74 to 0.97) and MRSA infections (17% monthly decrease, aIRR 0.83, 95% Cl 0.69 to 0.99).Conclusions: 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.