Successful control of a Methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit: a retrospective, before-after study
Aim of this study was to provide a detailed description of a Methicillin-resistant Staphylococcus aureus (MRSA) outbreak management strategy in the neonatal intensive care unit of a university hospital. This was a retrospective, "before-after" study, over two consecutive 18-month periods....
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| Veröffentlicht in: | BMC infectious diseases 2013-09, Vol.13 (1), p.440-440, Article 440 |
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| creator | Iacobelli, Silvia Colomb, Benoit Bonsante, Francesco Astruc, Karine Ferdynus, Cyril Bouthet, Marie-France Neuwirth, Catherine Aho Glélé, Ludwig Serge Chavanet, Pascal Gouyon, Jean-Bernard |
| description | Aim of this study was to provide a detailed description of a Methicillin-resistant Staphylococcus aureus (MRSA) outbreak management strategy in the neonatal intensive care unit of a university hospital.
This was a retrospective, "before-after" study, over two consecutive 18-month periods. The outbreak management strategy was performed by a multidisciplinary team and included: extensive healthcare workers (HCW) involvement, education, continuous hand-hygiene training and active MRSA colonization surveillance. The actions implemented were identified based on an anonymous, voluntary, reporting system, carried out among all the HCW, and regular audit and feedback were provided to the nursing staff. The main measured outcome was the rate of MRSA infections before and after the implementation of the outbreak management strategy. Piecewise linear Poisson regression was performed and the model adjusted for confounding variables. The secondary outcome was the rate of laboratory-confirmed bloodstream infections before and after the outbreak management strategy. The rates of MRSA colonization, implementation of proposed actions, observed compliance for hand-hygiene and insertion/care of central lines were also recorded during the second period.
1015 newborns were included. The rate of MRSA infections throughout the two periods fell from 3.5 to 0.7 cases per 1000 patient-days (p=0.0005). The piecewise Poisson regression analysis adjusted for confounding variables showed a significant decrease in the MRSA infection rate after the outbreak management strategy (p=0.046). A significant decrease in positive laboratory confirmed blood cultures was observed over the two periods (160 vs 83; p |
| doi_str_mv | 10.1186/1471-2334-13-440 |
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This was a retrospective, "before-after" study, over two consecutive 18-month periods. The outbreak management strategy was performed by a multidisciplinary team and included: extensive healthcare workers (HCW) involvement, education, continuous hand-hygiene training and active MRSA colonization surveillance. The actions implemented were identified based on an anonymous, voluntary, reporting system, carried out among all the HCW, and regular audit and feedback were provided to the nursing staff. The main measured outcome was the rate of MRSA infections before and after the implementation of the outbreak management strategy. Piecewise linear Poisson regression was performed and the model adjusted for confounding variables. The secondary outcome was the rate of laboratory-confirmed bloodstream infections before and after the outbreak management strategy. The rates of MRSA colonization, implementation of proposed actions, observed compliance for hand-hygiene and insertion/care of central lines were also recorded during the second period.
1015 newborns were included. The rate of MRSA infections throughout the two periods fell from 3.5 to 0.7 cases per 1000 patient-days (p=0.0005). The piecewise Poisson regression analysis adjusted for confounding variables showed a significant decrease in the MRSA infection rate after the outbreak management strategy (p=0.046). A significant decrease in positive laboratory confirmed blood cultures was observed over the two periods (160 vs 83; p<0.0001). A significant decline in the MRSA colonization rate occurred over the second period (p=0.001); 93% of the proposed actions were implemented. The compliance rate for hand-hygiene and insertion/care of central lines was respectively 95.9% and 62%.
The implementation of multiple, simultaneous, evidence-based management strategies is effective for controlling nosocomial infections. Outbreak management strategies may benefit from tools improving the communication between the institutional and scientific leadership and the ground-level staff. These measures can help to identify individualized solutions addressing specific unit needs.</description><identifier>ISSN: 1471-2334</identifier><identifier>EISSN: 1471-2334</identifier><identifier>DOI: 10.1186/1471-2334-13-440</identifier><identifier>PMID: 24053628</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Analysis ; Blood ; Control ; Cross infection ; Cross Infection - epidemiology ; Cross Infection - microbiology ; Cross Infection - prevention & control ; Design ; Epidemics ; Female ; France ; Gynecology and obstetrics ; Hospitalization ; Human health and pathology ; Humans ; Hygiene ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases - epidemiology ; Infant, Newborn, Diseases - microbiology ; Infant, Newborn, Diseases - prevention & control ; Intensive care ; Intensive Care Units, Neonatal - statistics & numerical data ; Life Sciences ; Male ; Medical examination ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus - drug effects ; Methicillin-Resistant Staphylococcus aureus - isolation & purification ; Methicillin-Resistant Staphylococcus aureus - physiology ; Neonatal intensive care units ; Newborn babies ; Nosocomial infections ; Nurses ; Patients ; Quality control ; Retrospective Studies ; Staphylococcal Infections - epidemiology ; Staphylococcal Infections - microbiology ; Staphylococcal Infections - prevention & control ; Staphylococcus aureus ; Staphylococcus infections ; Teaching hospitals</subject><ispartof>BMC infectious diseases, 2013-09, Vol.13 (1), p.440-440, Article 440</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Iacobelli et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Attribution</rights><rights>Copyright © 2013 Iacobelli et al.; licensee BioMed Central Ltd. 2013 Iacobelli et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c587t-8a60fa9ee52fba5111440c1bf37cd4ab35f1a33aa687048e24fbbc3acbcd74e93</citedby><cites>FETCH-LOGICAL-c587t-8a60fa9ee52fba5111440c1bf37cd4ab35f1a33aa687048e24fbbc3acbcd74e93</cites><orcidid>0000-0002-6010-8238 ; 0000-0003-0998-0669 ; 0000-0002-6243-0909</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849690/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849690/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24053628$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.univ-reunion.fr/hal-01477019$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Iacobelli, Silvia</creatorcontrib><creatorcontrib>Colomb, Benoit</creatorcontrib><creatorcontrib>Bonsante, Francesco</creatorcontrib><creatorcontrib>Astruc, Karine</creatorcontrib><creatorcontrib>Ferdynus, Cyril</creatorcontrib><creatorcontrib>Bouthet, Marie-France</creatorcontrib><creatorcontrib>Neuwirth, Catherine</creatorcontrib><creatorcontrib>Aho Glélé, Ludwig Serge</creatorcontrib><creatorcontrib>Chavanet, Pascal</creatorcontrib><creatorcontrib>Gouyon, Jean-Bernard</creatorcontrib><title>Successful control of a Methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit: a retrospective, before-after study</title><title>BMC infectious diseases</title><addtitle>BMC Infect Dis</addtitle><description>Aim of this study was to provide a detailed description of a Methicillin-resistant Staphylococcus aureus (MRSA) outbreak management strategy in the neonatal intensive care unit of a university hospital.
This was a retrospective, "before-after" study, over two consecutive 18-month periods. The outbreak management strategy was performed by a multidisciplinary team and included: extensive healthcare workers (HCW) involvement, education, continuous hand-hygiene training and active MRSA colonization surveillance. The actions implemented were identified based on an anonymous, voluntary, reporting system, carried out among all the HCW, and regular audit and feedback were provided to the nursing staff. The main measured outcome was the rate of MRSA infections before and after the implementation of the outbreak management strategy. Piecewise linear Poisson regression was performed and the model adjusted for confounding variables. The secondary outcome was the rate of laboratory-confirmed bloodstream infections before and after the outbreak management strategy. The rates of MRSA colonization, implementation of proposed actions, observed compliance for hand-hygiene and insertion/care of central lines were also recorded during the second period.
1015 newborns were included. The rate of MRSA infections throughout the two periods fell from 3.5 to 0.7 cases per 1000 patient-days (p=0.0005). The piecewise Poisson regression analysis adjusted for confounding variables showed a significant decrease in the MRSA infection rate after the outbreak management strategy (p=0.046). A significant decrease in positive laboratory confirmed blood cultures was observed over the two periods (160 vs 83; p<0.0001). A significant decline in the MRSA colonization rate occurred over the second period (p=0.001); 93% of the proposed actions were implemented. The compliance rate for hand-hygiene and insertion/care of central lines was respectively 95.9% and 62%.
The implementation of multiple, simultaneous, evidence-based management strategies is effective for controlling nosocomial infections. Outbreak management strategies may benefit from tools improving the communication between the institutional and scientific leadership and the ground-level staff. These measures can help to identify individualized solutions addressing specific unit needs.</description><subject>Analysis</subject><subject>Blood</subject><subject>Control</subject><subject>Cross infection</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - prevention & control</subject><subject>Design</subject><subject>Epidemics</subject><subject>Female</subject><subject>France</subject><subject>Gynecology and obstetrics</subject><subject>Hospitalization</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hygiene</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infant, Newborn, Diseases - epidemiology</subject><subject>Infant, Newborn, Diseases - microbiology</subject><subject>Infant, Newborn, Diseases - prevention & control</subject><subject>Intensive care</subject><subject>Intensive Care Units, Neonatal - statistics & numerical data</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Medical examination</subject><subject>Methicillin Resistance</subject><subject>Methicillin-Resistant Staphylococcus aureus - drug effects</subject><subject>Methicillin-Resistant Staphylococcus aureus - isolation & purification</subject><subject>Methicillin-Resistant Staphylococcus aureus - physiology</subject><subject>Neonatal intensive care units</subject><subject>Newborn babies</subject><subject>Nosocomial infections</subject><subject>Nurses</subject><subject>Patients</subject><subject>Quality control</subject><subject>Retrospective Studies</subject><subject>Staphylococcal Infections - epidemiology</subject><subject>Staphylococcal Infections - microbiology</subject><subject>Staphylococcal Infections - prevention & control</subject><subject>Staphylococcus aureus</subject><subject>Staphylococcus infections</subject><subject>Teaching hospitals</subject><issn>1471-2334</issn><issn>1471-2334</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkkuP0zAQxyMEYh9w54QicQGJgB07ibMHpGoF7EpFK1Hgak3ccesljYsf1fZz8IVx1NJ9nPY09sxvZjQz_yx7RckHSkX9kfKGFiVjvKCs4Jw8yY4Prqd33kfZiffXhNBGlO3z7KjkpGJ1KY6zv7OoFHqvY58rOwRn-9zqHPJvGJZGmb43Q-HQGx9gCPkswHq57a2ySkWfQ3SYjI2hcwi_czOkzAHtAAH69As4eLPBXIHDPA4mnKW4w9TFr1GFFHqfd6itwwJ0QJf7EOfbF9kzDb3Hl3t7mv388vnH-UUxvfp6eT6ZFqoSTSgE1ERDi1iVuoOKUpo2oGinWaPmHDpWaQqMAdSiIVxgyXXXKQaqU_OGY8tOs0-7uuvYrXCuMI0PvVw7swK3lRaMvB8ZzFIu7EYywdu6JanAu12B5YO0i8lUjj6SLtAQ2m5oYt_umzn7J6IPcmW8wr6HtK_oJeVVS3nb8uoRKBcl5YyM6JsH6LWNbkhbSxQTom2YKG-pBfQozaBtGkeNReWkYrwmgoj2dpo9NcoBb8ICovfycvb98ezVr_ss2bEqnd071IdVUSJHGctRp3LUqaRMpiOmlNd3L3NI-K9b9g_2Qu2V</recordid><startdate>20130922</startdate><enddate>20130922</enddate><creator>Iacobelli, Silvia</creator><creator>Colomb, Benoit</creator><creator>Bonsante, Francesco</creator><creator>Astruc, Karine</creator><creator>Ferdynus, Cyril</creator><creator>Bouthet, Marie-France</creator><creator>Neuwirth, Catherine</creator><creator>Aho Glélé, Ludwig Serge</creator><creator>Chavanet, Pascal</creator><creator>Gouyon, Jean-Bernard</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QL</scope><scope>7T2</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PIMPY</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6010-8238</orcidid><orcidid>https://orcid.org/0000-0003-0998-0669</orcidid><orcidid>https://orcid.org/0000-0002-6243-0909</orcidid></search><sort><creationdate>20130922</creationdate><title>Successful control of a Methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit: a retrospective, before-after study</title><author>Iacobelli, Silvia ; Colomb, Benoit ; Bonsante, Francesco ; Astruc, Karine ; Ferdynus, Cyril ; Bouthet, Marie-France ; Neuwirth, Catherine ; Aho Glélé, Ludwig Serge ; Chavanet, Pascal ; Gouyon, Jean-Bernard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c587t-8a60fa9ee52fba5111440c1bf37cd4ab35f1a33aa687048e24fbbc3acbcd74e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Analysis</topic><topic>Blood</topic><topic>Control</topic><topic>Cross infection</topic><topic>Cross Infection - epidemiology</topic><topic>Cross Infection - microbiology</topic><topic>Cross Infection - prevention & control</topic><topic>Design</topic><topic>Epidemics</topic><topic>Female</topic><topic>France</topic><topic>Gynecology and obstetrics</topic><topic>Hospitalization</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hygiene</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infant, Newborn, Diseases - epidemiology</topic><topic>Infant, Newborn, Diseases - microbiology</topic><topic>Infant, Newborn, Diseases - prevention & control</topic><topic>Intensive care</topic><topic>Intensive Care Units, Neonatal - statistics & numerical data</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Medical examination</topic><topic>Methicillin Resistance</topic><topic>Methicillin-Resistant Staphylococcus aureus - drug effects</topic><topic>Methicillin-Resistant Staphylococcus aureus - isolation & purification</topic><topic>Methicillin-Resistant Staphylococcus aureus - 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Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iacobelli, Silvia</au><au>Colomb, Benoit</au><au>Bonsante, Francesco</au><au>Astruc, Karine</au><au>Ferdynus, Cyril</au><au>Bouthet, Marie-France</au><au>Neuwirth, Catherine</au><au>Aho Glélé, Ludwig Serge</au><au>Chavanet, Pascal</au><au>Gouyon, Jean-Bernard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Successful control of a Methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit: a retrospective, before-after study</atitle><jtitle>BMC infectious diseases</jtitle><addtitle>BMC Infect Dis</addtitle><date>2013-09-22</date><risdate>2013</risdate><volume>13</volume><issue>1</issue><spage>440</spage><epage>440</epage><pages>440-440</pages><artnum>440</artnum><issn>1471-2334</issn><eissn>1471-2334</eissn><abstract>Aim of this study was to provide a detailed description of a Methicillin-resistant Staphylococcus aureus (MRSA) outbreak management strategy in the neonatal intensive care unit of a university hospital.
This was a retrospective, "before-after" study, over two consecutive 18-month periods. The outbreak management strategy was performed by a multidisciplinary team and included: extensive healthcare workers (HCW) involvement, education, continuous hand-hygiene training and active MRSA colonization surveillance. The actions implemented were identified based on an anonymous, voluntary, reporting system, carried out among all the HCW, and regular audit and feedback were provided to the nursing staff. The main measured outcome was the rate of MRSA infections before and after the implementation of the outbreak management strategy. Piecewise linear Poisson regression was performed and the model adjusted for confounding variables. The secondary outcome was the rate of laboratory-confirmed bloodstream infections before and after the outbreak management strategy. The rates of MRSA colonization, implementation of proposed actions, observed compliance for hand-hygiene and insertion/care of central lines were also recorded during the second period.
1015 newborns were included. The rate of MRSA infections throughout the two periods fell from 3.5 to 0.7 cases per 1000 patient-days (p=0.0005). The piecewise Poisson regression analysis adjusted for confounding variables showed a significant decrease in the MRSA infection rate after the outbreak management strategy (p=0.046). A significant decrease in positive laboratory confirmed blood cultures was observed over the two periods (160 vs 83; p<0.0001). A significant decline in the MRSA colonization rate occurred over the second period (p=0.001); 93% of the proposed actions were implemented. The compliance rate for hand-hygiene and insertion/care of central lines was respectively 95.9% and 62%.
The implementation of multiple, simultaneous, evidence-based management strategies is effective for controlling nosocomial infections. Outbreak management strategies may benefit from tools improving the communication between the institutional and scientific leadership and the ground-level staff. These measures can help to identify individualized solutions addressing specific unit needs.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24053628</pmid><doi>10.1186/1471-2334-13-440</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-6010-8238</orcidid><orcidid>https://orcid.org/0000-0003-0998-0669</orcidid><orcidid>https://orcid.org/0000-0002-6243-0909</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | BMC infectious diseases, 2013-09, Vol.13 (1), p.440-440, Article 440 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; SpringerLink Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; PubMed Central Open Access; Springer Nature OA Free Journals |
| subjects | Analysis Blood Control Cross infection Cross Infection - epidemiology Cross Infection - microbiology Cross Infection - prevention & control Design Epidemics Female France Gynecology and obstetrics Hospitalization Human health and pathology Humans Hygiene Infant Infant, Newborn Infant, Newborn, Diseases - epidemiology Infant, Newborn, Diseases - microbiology Infant, Newborn, Diseases - prevention & control Intensive care Intensive Care Units, Neonatal - statistics & numerical data Life Sciences Male Medical examination Methicillin Resistance Methicillin-Resistant Staphylococcus aureus - drug effects Methicillin-Resistant Staphylococcus aureus - isolation & purification Methicillin-Resistant Staphylococcus aureus - physiology Neonatal intensive care units Newborn babies Nosocomial infections Nurses Patients Quality control Retrospective Studies Staphylococcal Infections - epidemiology Staphylococcal Infections - microbiology Staphylococcal Infections - prevention & control Staphylococcus aureus Staphylococcus infections Teaching hospitals |
| title | Successful control of a Methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit: a retrospective, before-after study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-15T13%3A01%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Successful%20control%20of%20a%20Methicillin-resistant%20Staphylococcus%20aureus%20outbreak%20in%20a%20neonatal%20intensive%20care%20unit:%20a%20retrospective,%20before-after%20study&rft.jtitle=BMC%20infectious%20diseases&rft.au=Iacobelli,%20Silvia&rft.date=2013-09-22&rft.volume=13&rft.issue=1&rft.spage=440&rft.epage=440&rft.pages=440-440&rft.artnum=440&rft.issn=1471-2334&rft.eissn=1471-2334&rft_id=info:doi/10.1186/1471-2334-13-440&rft_dat=%3Cgale_pubme%3EA534608089%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1438897382&rft_id=info:pmid/24053628&rft_galeid=A534608089&rfr_iscdi=true |