Author/Editor		Tomič, Viktorija; Svetina-Šorli, Petra; Trinkaus, Darinka; Šorli, Jurij; Widmer, Andreas; Trampuž, Andrej
Title		Uspešni nadzor bolnišničnega širjenja proti meticilinu odporne bakterije Staphylococcus aureus (MRSA)
Translated title		Control of nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA)
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. 12
Publication year		2003
Volume		str. 665-9
Language		slo
Abstract		Background. This prospective cohort study presents the effectiveness and feasibility of a comprehensive control strategy to reduce nosocomial transmission of methicillin resistant Staphylococcus aureus (MRSA) in a highly endemic setting. Methods. All patients with MRSA carriage admitted to the University Clinic of Respiratory and Allergic Diseases over a period of 5 years (January 1998 through December 2002) were included and categorized into imported or hospitalacquired cases. In January 1999 an aggressive infection control program was implemented. It was focused on promoting alcohol hand rub, obtaining active surveillance cultures for MRSA, implementing strict barrier precautions and decolonizing MRSA carriers. Results. MRSA was recovered from 223 hospitalized patients; 142 cases were imported and 81 were acquired at our institution. After the introduction of an active surveillance program, the annual incidence of detected MRSA carriage per 1000 admissions first increased from 4.5 in 1998 to 8.0 in 1999 (p = 0.019), but remained stable thereafter The proportion of patients detected through active surveillance cultures progressively increasedfrom 23% in 1999 to 78% in 2002. Since 1999, the proportion of acquired MRSA cases in our institution has steadily decreased from 50% in 1999 to 6% in 2002 (p < 0.001), whereas the proportion of patients who acquired MRSA in other hospitals (p < 0.001) and nursing homes (p = 0.025) has increased. Conclusions. With a comprehensive infection control program it is possible to substantially reduce nosocomial transmission of MRSA in a highly endemic area. With good hand hygiene, early detection, isolation and decolonization strategy, containment of MRSA is achievable despite a high rate of transferred patients colonized or infected with MRSA from other healthcare facilities.
Summary		Izhodišča. Proti meticilinu odporna bakterija Staphylococcus aureus (MRSA) predstavlja precejšen problem v svetu in tudi pri nas. V naši ustanovi smo želeli oceniti učinkovitost in izvedljivost strategije strogega nadzora okužb (angl. infection control strategy) za zmanjšanje bolnišničnih prenosov MRSA. Metode. Vse z MRSA kolonizirane bolnike, ki so bili sprejeti na Klinični oddelek za pljučne bolezni in alergijo Golnik v petletnem obdobju (januar 1998 - december 2002), smo razvrstili v dve skupini: vneseni primeri MRSA in pridobljeni v naši ustanovi. Januarja 1999 smo začeli uvajati strogi program nadzora in preprečevanja prenosa MRSA. Zajemal je razkuževanje rok namesto umivanja odvzem nadzornih kužnin, kontaktno izolacijo koloniziranih bolnikov in dekolonizacijo nosilcev MRSA. Rezultati. V petletnem obdobju smo MRSA osamili pri 223 bolnikih; 142 primerov je bilo vnesenih, 81 bolnikov je MRSA pridobilo v naši ustanovi. Po uvedbi odvzema nadzornih kužnin je letna incidenca odkritih MRSA porasla s 4, 5/1000 sprejemov leta 1998 na 8,0/1000 sprejemov leta 1999 (p = 0, 019) nato se ni bistveno spreminjala. Delež koloniziranih bolnikov, odkritih z nadzornimi kužninami, je postopno porasel s 23% leta 1999 na 78% leta 2002. Od leta 1999 naprej je delež v naši ustanovi pridobljenih MRSA nenehno upadal s 50% leta 1999 na 6% leta 2002 (p < 0, 001), medtem ko se je povečeval delež vnesenih MRSA (p = 0, 025). Zaključki. Z obsežnim programom nadzora in preprečevanja prenosa MRSA je mogoče pomembno zmanjšati število bolnišničnih prenosov MRSA v visoko endemskem področju. Kljub stalnemu dotoku z MRSA koloniziranih bolnikov iz drugih zdravstvenih ustanov lahko z ustrezno higieno rok, zgodnjim odkrivanjem nosilcev, kontaktno izolacijo in dekolonizacijo bolnikov obvladamo problem MRSA.
Descriptors		STAPHYLOCOCCAL INFECTIONS STAPHYLOCOCCUS AUREUS METHICILLIN RESISTANCE CROSS INFECTION CONTROLLED CLINICAL TRIALS