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CME/CE

ICU Cleaning Intervention May Reduce MRSA, VRE Transmission

  • Authors: News Author: Emma Hitt, PhD
    CME Author: Penny Murata, MD
  • CME/CE Released: 4/5/2011
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 4/5/2012, 11:59 PM EST
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Target Audience and Goal Statement

This article is intended for primary care clinicians, hospitalists, infectious disease specialists, and other specialists who provide care to hospitalized patients.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Report whether a cleaning intervention reduces the transmission of MRSA and the risk for MRSA acquisition in hospitalized patients if the previous room occupant was MRSA-positive.
  2. Report whether a cleaning intervention reduces the transmission of vancomycin-resistant enterococci infection and the risk for acquisition of this infection in hospitalized patients if the previous room occupant was vancomycin-resistant enterococci–positive.


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Emma Hitt, PhD

    Emma Hitt is a freelance editor and writer for Medscape.

    Disclosures

    Disclosure: Emma Hitt, PhD, has disclosed no relevant financial relationships.
    Dr. Hitt does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.
    Dr. Hitt does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

  • Brande Nicole Martin

    CME Clinical Editor, Medscape, LLC

    Disclosures

    Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.

CME Author

  • Penny Murata, MD

    Clinical Professor, Pediatrics, University of California, Irvine, California
    Pediatric Clerkship Director, University of California, Irvine, California

    Disclosures

    Disclosure: Penny Murata, MD, has disclosed no relevant financial relationships.

CME Reviewer

  • Sarah Fleischman

    CME Program Manager, Medscape, LLC

    Disclosures

    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

Nurse Planner

  • Laurie E. Scudder, DNP, NP

    Nurse Planner, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC

    Disclosures

    Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.


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CME/CE

ICU Cleaning Intervention May Reduce MRSA, VRE Transmission

Authors: News Author: Emma Hitt, PhD CME Author: Penny Murata, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME/CE Released: 4/5/2011

Valid for credit through: 4/5/2012, 11:59 PM EST

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April 5, 2011 — Enhanced intensive care unit (ICU) cleaning involving disinfectant-saturated cleaning cloths, an educational campaign, and targeted feedback may reduce methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) transmission. The risk for MRSA acquisition may also be eliminated from a MRSA-positive room occupant, according to the findings of a recent cohort study.

Rupak Datta, MPH, with the University of California Irvine School of Medicine and colleagues reported their findings in the March 28, 2011, issue of the Archives of Internal Medicine.

According to the researchers, contamination with multidrug-resistant bacteria is particularly important in ICUs, as patients are at high risk for infection from comorbidities, wounds, and the use of medical devices.

Previous studies have shown that an intervention including repeated immersion of cleaning cloths into disinfectant-filled containers, cleaning efficiency feedback, and an educational campaign reduced MRSA and VRE room contamination. The current retrospective cohort study was designed to assess the effect of this cleaning intervention on the risk for MRSA and VRE acquisition from prior room occupants.

A total of 9449 patients admitted to 10 ICUs at a 750-bed academic medical center from September 1, 2006, through April 30, 2008, during the enhanced cleaning intervention, were compared vs a baseline of 8203 patients admitted from September 1, 2003, through April 30, 2005.

The enhanced cleaning intervention resulted in a reduction in MRSA and VRE vs baseline. MRSA was reduced from 3.0% to 1.5% (P < .001), and VRE was reduced from 3.0% to 2.2% (P < .001). Patients in rooms previously occupied by carriers showed increased contamination in the baseline group (3.9% vs 2.9%; = .03) but not in the intervention group (1.5% vs 1.5%; P = .79) for MRSA. However, for VRE, an increased risk was seen at baseline (4.5% vs 2.8%; P = .001) and during intervention (3.5% vs 2.0%; P < .001).

Additional studies to evaluate the differential effect of enhanced cleaning on MRSA and VRE are needed. This may be especially applicable to healthcare settings with a high prevalence of VRE where rigorous cleaning methods may be indicated.

The study was supported by the National Institutes of Health. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2011;171:491-494. Abstract

Related Link
Management of Patients With Infections Caused by Methicillin-Resistant Staphylococcus Aureus: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) is available online.

Clinical Context

Patients admitted to the ICU have a 40% increased risk of acquiring MRSA or VRE infection if the previous occupants were MRSA or VRE positive, according to Huang and colleagues in the October 9, 2006, issue of the Archives of Internal Medicine. In the July 2008 issue of Infection Control and Hospital Epidemiology, Goodman and colleagues described a cleaning intervention that reduced the MRSA and VRE contamination of ICU rooms.

This retrospective cohort study assesses whether the cleaning intervention decreases the risk for MRSA and VRE acquisition from prior occupants of the hospital room.

Study Highlights

  • Eligible patients were occupants of the medical, cardiac, burn/trauma, general surgery, cardiac surgery, thoracic surgery, and neurosurgery ICUs at a single medical center.
  • Patients eligible for acquiring MRSA or VRE had no history of MRSA or VRE before being admitted to the hospital and no MRSA-positive or VRE-positive culture result within 2 days of admission.
  • Exclusion criterion was MRSA or VRE carrier status on admission.
  • During the baseline period from 2003 to 2005, a quaternary ammonium cleaning agent was used.
  • During the intervention period from 2006 to 2008, additional cleaning included use of a tracking marker and ultraviolet light for targeted feedback of the adequacy of cleaning; immersion of cleaning cloths into buckets; and education about the importance of repeated bucket immersion during cleaning.
  • 7629 patients at baseline and 8716 patients during intervention were MRSA eligible.
  • 7806 patients at baseline and 8824 patients during intervention were VRE eligible.
  • Median age of the patients was 62 years.
  • 56% to 57% were men.
  • MRSA acquisition was lower during intervention (182 [1.5%] of 11,849) vs baseline (305 [3.0%] of 10,151; P < .001).
  • At baseline, MRSA acquisition was higher if the prior occupant was MRSA positive vs MRSA negative (3.9% vs 2.9%; P = .03).
  • During intervention, MRSA acquisition was similar if the prior occupant was MRSA positive vs MRSA negative (1.5% vs 1.5%; P = .79).
  • An MRSA-positive prior occupant predicted MRSA acquisition at baseline (odds ratio [OR], 1.4; P = .04) but not during intervention (OR, 1.1).
  • VRE acquisition was lower during intervention (256 [2.2%] of 11,871) vs baseline (314 [3.0%] of 10,349; P < .001).
  • At baseline, VRE acquisition was higher if the prior occupant was VRE positive vs VRE negative (4.5% vs 2.8%; P = .001).
  • During intervention, VRE acquisition was also higher if the prior occupant was VRE positive vs VRE negative (3.5% vs 2.0%; P < .001).
  • A VRE-positive prior occupant predicted VRE acquisition at baseline (OR, 1.4; P = .02) and during intervention (OR, 1.4; P = .04).
  • Analysis adjusted for age, sex, comorbidities, pre-ICU length of stay, prior occupant length of stay, duration of room vacancy before occupancy, and clustering by ICU ward.
  • Study limitations included lack of data on antibiotic use.

Clinical Implications

  • A cleaning intervention reduces the transmission of MRSA and decreases the risk for MRSA acquisition in hospitalized patients if the previous room occupant was MRSA-positive.
  • A cleaning intervention reduces the transmission of VRE but not the risk for VRE acquisition in hospitalized patients if the previous room occupant was VRE-positive.

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