Cleaning intervention reduced MRSA transmission in ICU

Instituting several simple steps to improve cleaning policies in the ICU may eliminate patients' risk for acquiring methicillin-resistant Staphylococcus aureus from a prior MRSA-positive room occupant, study results published in the Archives of Internal Medicine indicate.

Earlier studies have shown that the risk for acquiring MRSA and vancomycin-resistant enterococci (VRE) infections is 40% higher for these patients, according to background information provided in the study.

The cleaning intervention, instituted at 10 ICUs in a 750-bed academic medical center reduced overall acquisition of MRSA by 49% and VRE by 29% compared with baseline.

Rupak Datta, MPH, of the University of California Irvine School of Medicine in Irvine, Calif., and colleagues, measured disease rates during a three-month time frame before (MRSA, n= 7,629; VRE, n=7,806) and after (MRSA, n=8,716; VRE, n=8,824) implementation of an enhanced cleaning protocol that featured three key components:

  • Feedback regarding the adequacy of environmental cleaning was provided with a novel, nontoxic-tracking marker with ink that is visible only under a black light;
  • Clinicians were advised to apply disinfectant solution with a cleaning cloth that had been immersed into a bucket of solution, rather than solution that had been poured from the bottle onto the cloth;
  • Educating health-care personnel about the importance of bucket-immersion cleaning techniques.

Overall, the researchers found that this intervention reduced acquisition rates for both diseases, from 3.0% to 1.5% for MRSA and 3.0% to 2.2% for VRE (P<.001 for both).

However, when disease acquisition rates were assessed by prior room occupant infection status, the researchers found that the intervention reduced the risk for MRSA transmission, but not VRE transmission.

Patients in rooms that were previously occupied by MRSA carriers had an increased risk for MRSA during baseline (3.9% vs. 2.9%, P=.03), but not during the intervention (1.5% vs. 1.5%, P=.79), whereas patients whose rooms were occupied by VRE-carriers had an increased risk during both time periods (baseline, 4.5 vs. 2.8%, P=.001; intervention, 3.5% vs. 2.0%, P<.001).

“Reasons for this difference may include the generally higher burden of VRE contamination and evidence that room contamination may be a major factor in VRE transmission,” the researchers wrote, noting that earlier trials have shown VRE contamination to persist even after three standard room cleanings.

They called for additional studies to evaluate the differences between enhanced cleaning protocols in MRSA and VRE prevention.

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