The effect of Methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle in reducing hospital-acquired MRSA rate in an acute public hospital in Hong Kong

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The effect of Methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle in reducing hospital-acquired MRSA rate in an acute public hospital in Hong Kong

 

Author: Leung, Wai Ching Carol
Title: The effect of Methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle in reducing hospital-acquired MRSA rate in an acute public hospital in Hong Kong
Degree: M.Sc.
Year: 2012
Subject: Staphylococcus aureus -- Prevention.
Nosocomial infections -- Prevention.
Hospital buildings -- Disinfection.
Hospitals -- Sanitation.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xv, 106 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2528189
URI: http://theses.lib.polyu.edu.hk/handle/200/6671
Abstract: Aim and objectives: The aim and the objectives of the study were to evaluate the effectiveness of Methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle and to identify the risk factors for hospital-acquired MRSA in an acute local hospital: (1) To determine and compare the hospital-acquired MRSA rate before and after implementation of MRSA prevention bundle in an acute hospital. (2) To determine the compliance rate of MRSA prevention bundle among ward nurses in an acute local hospital. (3) To determine the risk factors for hospital-acquired MRSA such as patients' demographic and usage health care devices. Design: Two designs were employed in the study: (1) a quasi-experimental study design to compare the rate of hospital-acquired MRSA before and after implementation of a MRSA prevention bundle (2) a retrospective case-control study design to identify the risk factors for hospital-acquired MRSA. Subjects: The hospital records of those patients who were admitted to the hospital over 48 hours with their specimens sent for culture in the period between 1 February 2010 and 30 April 2011 were reviewed in the study. The hospital records of hospital-acquired MRSA patients were reviewed in the quasi-experimental study and an equal number of the hospital records of those patients without hospital-acquired MRSA were reviewed for the case-control study. Intervention: The pre-intervention period was from 1 February 2010 to 31 July 2010. The MRSA prevention bundle was implemented gradually in all wards from 1 August 2010 to 31 October 2010. The MRSA prevention bundle included active surveillance of high risk patients, central line bundle, hand hygiene, contact precautions, designated equipment, room isolation, disinfection of environment, chlorhexidine bath, checklist for acute MRSA patients and alert system. The post-intervention period was from 1 November 2010 to 30 April 2011.
Results: A total of 75 and 91 hospital-acquired MRSA patients were identified in pre- and post-intervention periods respectively. Despite the implementation of MRSA prevention bundle, the hospital-acquired MRSA isolation rate did not decline (t-test=-4.38; df=164; p=0.31). When analyzing the type of specimens infected with MRSA, there was a significant reduction in wound specimens in the post-intervention period (X² test=5.75; df=1; p=0.02). Regarding the compliance rate of MRSA prevention bundle, medical unit had higher compliance rate of infection control measures for acute MRSA patients in the post-intervention period (X² test=49.31; df=1; p<0.001), while the surgical unit showed higher compliance rate of infection control measures for both old MRSA patients (Fisher's Exact test, p=0.02) and acute MRSA patients (Fisher's Exact test, p<0.001) in the post-intervention period. Regarding the active surveillance of high risk patients, 62% patients were successfully decolonized in the study. In addition, compliance rates of hand hygiene and environment disinfection were 69% and 91 %, respectively. Multivariate analysis showed that age above 60 (Odd Ratio (OR)=2.43; 95% Confidence Interval (CI)=1.01-5.88), elderly home residents (OR=4.26; 95% CI=2.25-8.07), prolonged hospitalization (more than 21 days) (OR=17.33; 95% CI=6.20-48.47) and patients with wounds (OR=2.21; 95% CI=1.13-4.30) were identified as the risk factors for hospital-acquired MRSA in the study. Conclusion: Despite implementation of MRSA prevention bundle, the hospital-acquired MRSA rate did not decline in the study. Further research with a longer period of study is needed to monitor the hospital-acquired MRSA rate. It is recommended that patients at higher risk of MRSA, including age above 60, elderly home residents, prolonged hospitalization (more than 21 days) and patients with wounds should be accommodated in an isolated area for cohort care.

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