Literature Update - June, 2003
Compiled by Dr Deb Friedman, VICNISS ID Physician
Nosocomial Pathogens
A group from Ohio (Donskey CJ et al. Infection Control Hospital Epidemiology, 2003;24(4):242-245.) recently looked at
whether or not patients colonised with VRE are at greater risk of colonisation with other nosocomial pathogens. A rectal
swab culture survey found that VRE-colonised patients were more likely to also be colonised with ceftazidime-resistant
gram-negative bacilli. In addition, the VRE colonised patients were more likely during 6-month follow-up to have
C.difficile-associated diarrhoea, or to be infected with MRSA or resistant gram-negative bacilli.
The findings of this study illustrate the importance of isolation measures to control VRE, given that they may well
also control other pathogens in this patient population.
Paediatric and Neonatal Intensive Care Unit Infection Rates
A multicentre collaboration in the USA among children’s hospitals was established in 1997. This group is aimed
at collecting surveillance data on nosocomial infections.
They have now published their infection rates, although the different formats used for reporting data have limited
the usefulness of the infection rates. They have however divided up their device-associated BSI rates by birthweight
category, and have shown that the highest infection rates are among neonate weighing <1000 grams.
VICNISS hospitals participating in surveillance in high-risk nurseries will be able to benchmark their data against
such US rates until more local rates are available.
From:
Girouard S, Levine G, Goodrich K et al. Pediatric Prevention Network: a multicenter collaboration to improve health outcomes. Am J Infect Control 2001;29:158-161.
Stover BH, Shulman ST, Bratcher DF, et al. Nosocomial infection rates in US children’s hospitals’ neonatal and pediatric intensive care units.
Am J Infect Control 2001;29:152-157.
Control of Nosocomial MRSA
In an enlightening editorial, Harbath and Pittet from Geneva discuss the current trend in control of MRSA, and refer to several recently published studies (Infect
Control Hosp Epidemiol 2003;24(5):314-316).
In particular, in places where MRSA is endemic, is it time to give up fighting and searching for MRSA? or should we focus increased efforts on screening policies
and isolation precautions?
Although MRSA is a global problem, there are many differences in the approaches adopted, and the degree of MRSA control that has been achieved.
The authors stress that standard precautions have not, and will not control MRSA. Rather, active screening cultures and contact isolation are required to
curb this problem. The new SHEA guidelines (see below) support this viewpoint.
Ultimately, MRSA control is cost-effective especially in high-risk units. However (for those who believe that this advice does not pertain to their smaller hospitals),
the authors conclude that there is no level of MRSA prevalence for which active control measures are not warranted!
The SHEA guidelines (Muto CA, Jernigan JA, Ostrowsky BE et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains
of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24(5):362-86) state that most facilities to date have not actively
identified colonised patients, leaving them undetected and unisolated.
They recommend:
- active surveillance cultures to identify the reservoir for spread of MRSA
- hand hygiene
- barrier precautions for patients known or suspected to be colonised with MRSA (gloves, gowns and masks)
- antibiotic stewardship
- decolonisation or suppression of colonised patients
Although many of our Australian hospitals do not currently have a problem with endemic MRSA, we should not be naïve about what the future may bring. We
must be committed to controlling the spread of MRSA and other resistant pathogens.