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CME/CE Released: 4/5/2011
Valid for credit through: 4/5/2012
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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%; P = .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.
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.
