by Michael Smith
It’s possible to reduce the burden of drug-resistant pathogens in hard-hit hospitals — all it takes is consistent effort over time, French researchers say.
That’s the conclusion after a 15-year, intensive program aimed at reducing the impact of methicillin-resistant Staphylococcus aureus (MRSA) on Parisian hospitals reported in the March 22 Archives of Internal Medicine.
The program started in 1993 in the 38-hospital, 23,000-bed Assistance Publique-Hôpitaux de Paris, the largest public medical institution in France, according to Vincent Jarlier, MD, PhD, of the Groupe Hospitalier Pitié Salpêtrière, in Paris, and colleagues.
It was a response to comparative European data showing that the proportion of MRSA among clinical strains of S. aureus in blood cultures in French hospitals had reached about 35% in the late 1980s, Jarlier’s group explained.
Among the hospitals in the Parisian system, the proportion of MRSA among clinical strains of S. aureus was even higher, at about 40%, the researchers noted, so officials decided to launch a campaign to reduce its incidence and prevalence.
The campaign, started in 1993, included:
* Placing patients with MRSA infection or colonization in single-bed rooms whenever possible
* Barrier precautions for such patients, including disposable gloves, disposable aprons worn for such activities as bed-making, and dedicated equipment (such as stethoscopes) for each patient
* Promotion of hand hygiene, initially with disinfectant soap and later with alcohol-based hand-rub solutions
* Active and passive identification of patients with MRSA
* Feedback on results
By 2007, Jarlier and colleagues said, the program produced a marked reduction in MRSA, both in terms of the proportion of resistant strains among all S. aureus isolates and the incidence of cases.
Specifically, they reported in the journal, the proportion of MRSA among S. aureus strains fell from 41.0% to 26.6% overall and from 45.3% to 24.2% in blood cultures.
At the same time, the incidence of MRSA cases fell from 0.86 per 1,000 hospital days to 0.56, they said.
The decline was more marked in intensive care units than in surgical wards, which, in turn, did better than medical wards, they said. The relative changes, respectively, were -59%, -44%, and -32%, respectively, but all were significant at P<0.001.
The same pattern occurred in incidence of cases, with a more marked decrease in ICUs.
On the other hand, Jarlier and colleagues said, in the system’s 15 rehabilitation and long-term care hospitals, the program was less effective. The proportion of MRSA among S. aureus strains remained high throughout the survey, ranging between 54% and 73%.
The system introduced alcohol-based hand-rubs in 2000 and saw the use of the germ-fighters — a crude marker for hand hygiene compliance — increase overall from two to 21 liters per 1,000 hospital days between 2000 and 2007.
Use of the solutions reached a higher level in acute care hospitals than in the rehabilitation and long-term care institutions at 26 and 10 liters per 1,000 hospital days, respectively.
The researchers cautioned that the study was observational and lacked a control group, making it difficult to conclude that the intervention caused the decline.
However, they said, “several facts” support such a conclusion, including the change in the MRSA trend from increasing before the intervention to falling afterward.
Michael Smith is a MedPage Today North American Correspondent