MRSA Module 3 Evidence-tabel
Publicatiedatum 19-01-2024 | 11:00
| Study reference | Study characteristics | Patient characteristics | Intervention (I) | Comparison / control (C) |
Follow-up | Outcome measures and effect size | Comments |
|---|---|---|---|---|---|---|---|
| Chuang (2015) | Type of study: Clustered RCT Setting and country: Residential care homes for the elderly (RCHEs) in Hong Kong. Funding and conflicts of interest: No conflicts of interest reported This study was supported by the Research Fund for the Control of Infectious Diseases (RFCID) of the Food and Health Bureau of Hong Kong SAR Government (grant number CHP-NS-04). |
Inclusion criteria: 50-300-bed RCHEs located in three geographic districts with the same hospital catchment – Kowloon City, Yau Tsim Mong and Wong Tai Sin Exclusion criteria: Not fulfilling inclusion criteria N total at baseline: 36 NHs – (N Int.=18; N cnt.=18) N=2776 - (N Int.=1505/ N cnt.=1271) Groups comparable at baseline? yes |
Describe intervention (treatment/procedure/test): - Introduce and install alcohol-based hand rubs at designated areas - Display poster demonstrating the Five Moments of correct hand hygiene indications and the Seven Steps of effective hand hygiene techniques from the World Health Organization - Provide color-coded cleaning kits along with protocol to the NHs - Isolate MRSA (meticilline-resistente Staphylococcus aureus ) carriers from vulnerable residents who had indwelling catheters or skin lesion - Reinforce contact precaution when handling the device and wounds of MRSA carrier - Allow MRSA carriers without any wounds or indwelling catheters to participate in social activities - Assess staff compliance with the interventions quarterly together with timely feedback to the stakeholders |
Describe control (treatment/procedure/test): Continue the usual practice |
Length of follow-up: 16 months Loss-to-follow-up: Not applicable Incomplete outcome data: No incomplete outcome data |
Outcome measures and effect size (include 95%CI and p-value if available): MRSA (Unk) colonization Prevalence Pre-int. Int.=316/1505 (21.0%) Cnt.=249/1271 (19.6%) OR: 1.11 (0.86,1.44); p=0.42 Post-int. (6mths) Int.=341/1480 (23.0%) Cnt.=239/1226 (19.5%) OR: 1.18 (0.87,1.60); p=0.30 Post-int.(9mths) Int.=304/1469 (20.7%) Cnt.=231/1184 (19.5%) OR: 1.06 (0.81,1.38); p=0.69 Post-int. (12mths) Int.=303/1446 (21.0%) Cnt.=243/1159 (21.0%) OR: 0.99 (0.74, 1.34); p=0.95 Post-int. (15mths) Int.=290/1367 (21.2%) Cnt.=229/1116 (20.5%) OR: 1.04 (0.72, 1.49); p=0.85 |
The study showed that relying on the infection control bundle alone could not bring sustainable MRSA reduction. Administrative control for strengthening infection control infrastructure is important for continuous compliance and improvement. |
| Lopez-Alcalde (2015) | Type of study: Systematic Review Setting and country: -. Funding and conflicts of interest: No conflicts of interest reported This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Wounds. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health, UK. |
Inclusion criteria: - Exclusion criteria: - N total at baseline: not applicable - Groups comparable at baseline?: not applicable - |
Describe intervention (treatment/procedure/test): The use of gloves, gowns, aprons or masks for interactions with the patient’s environment |
Describe control (treatment/procedure/test): Any comparator provided that it allowed the eOect of gloving, gowning or masking on MRSA transmission to be separated out. |
Length of follow-up: Not applicable Loss-to-follow-up: Not applicable Incomplete outcome data: Not applicable |
Outcome measures and effect size (include 95%CI and p-value if available): Not applicable |
No eligible studies for this review, either completed or ongoing were identified. |
| Furuya (2018) | Type of study: Retrospective, nonrandomized observational study. Setting and country: 800-bed adult academic medical center in New York City. Funding and conflicts of interest: This study was funded by a grant from the National Institute of Nursing Research, National Institutes of Health (grant no. R01 NR010822). No conflicts of interest declared. |
Inclusion criteria: Data extracted from a clinical research database for 2006–2014 of all 6 ICUs in an 800-bed adult academic tertiary-care hospital. These 6 ICUs include 2 medical ICUs (MICU-1 and -2), a surgical ICU (SICU), a cardiac ICU (CCU), a cardiothoracic surgical ICU (CTICU), and a neurological ICU (NICU). Exclusion criteria: NI N total at baseline: NI Groups comparable at baseline? NI |
Describe intervention (treatment/procedure/test): Universal contact precautions (universal gowning and gloving) |
Describe control (treatment/procedure/test): No universal contact precautions |
Length of follow-up: 9 years Loss-to-follow-up: Not reported Incomplete outcome data: Not reported |
Outcome measures and effect size (include 95%CI and p-value if available): Hospital-onset incidence density rates for MRSA: no significant decrease observed (P=0.112) |
The results of this 9-year study suggest that decreases in MDROs, including multidrug-resistant gram-negative bacilli, were more likely due to hospital-wide improvements in infection prevention during this period and that UCP had no detectable additional impact. |
| Shahbaz (2020) | Type of study: Retrospective cohort study Setting and country: Infants who screened positive for MRSA (or MSSA) at two level III-IV University of California, Los Angeles NICU Funding and conflicts of interest: No conflicts of interest or funding disclosed. |
Inclusion criteria: Infants tested positive for MRSA or MSSA Exclusion criteria: Noncolonized infants matched by gestational age during same time period N total at baseline: 83 patients with a positive surveillance cultures, 151 with negative screens 133 patients in cohort during contact precautions, 101 patients in the cohort after contact precautions were discontinued. Groups comparable at baseline?: No, colonized patients were of younger gestational age, smaller birth weight, lower 1’ and 5’ Apgar scores compared to non-colonized patients. |
Describe intervention (treatment/procedure/test): Contact precautions (CP) – long sleeve gown, non-sterile gloves worn by healthcare provider and visitors during any care that required contact with the infant or the incubator. |
Describe control (treatment/procedure/test): Eliminated contact precautions regardless of colonization status. |
Length of follow-up: Loss-to-follow-up: NA Incomplete outcome data: NA |
Outcome measures and effect size (include 95%CI and p-value if available): MRSA incidence/colonization 28.6% during CP vs 44.6% after CP (P=0.010) |
The authors conclude that there was a lower incidence of S.aureus colonization during a time when contact precautions were utilized. Contact precautions may be an effective means of decreasing colonization rates. |
| Morgan (2020) | Type of study: Controlled before-after study Setting and country: United States Department of Veterans Affairs, Long term care facilities Funding and conflicts of interest: D. J. M. has received grants as an investigator for the United States Department of Veterans Affairs Health Services Research and develop-ment Service (HSR&D), the CDC (Centers for Disease Control and Prevention), and National Institutes of Health; received grants as an investigator or co-investigator for the Agency for Healthcare Research and Quality; received a Merit Award for infection control work from the HSR&D; received travel expenses from the IDSA and SHEA; and received textbook and journal honoraria from Springer Nature Inc. M. Z. has received a grant as a co-investigator from the HSR&D. M.-C. R. has received multiple grants as an investigator and co-investigator from the CDC and received a grant as an investigator from the National Institute of Allergy and Infectious Diseases. Study was supported by the United States Department of Veterans Affairs Health Services Research & development |
Inclusion criteria: Residents were included if they had an initial surveillance culture on admission that was negative for MRSA and at least 1 additional culture was collected Exclusion criteria: Not fulfilling inclusion criteria – residents were excluded from the cohort after having any positive MRSA culture. N total at baseline: 74 LTCFs N Int.=45; N cnt.=28 N=75414 N Int.=45167 / N Cnt.=30247 Groups comparable at baseline? yes |
Describe intervention (treatment/procedure/test): Apply contact precaution - Use of gowns and gloves for all contact with residents or with the environment within their rooms for those residents colonized or infected with MRSA |
Describe control (treatment/procedure/test): Apply standard precaution (basic self-hygiene) |
Length of follow-up: 48 months Loss-to-follow-up: Not applicable Incomplete outcome data: No incomplete outcome data |
Outcome measures and effect size (include 95%CI and p-value if available): MRSA (Unk) acquisition Prevalence (/1000 patient-days) Int.= 2.55 (0.25%) Cnt.= 2.54 (0.26%) MRSA associated infections Infections (/1000 patient-days) Int.= 0.14 (0.01%) Cnt.= 0.11 (0.01%) |
The authors conclude that contact precaution was not more effective in reducing MRSA acquisition and infection compared to standard precaution. |
| Schrank (2020) | Type of study: Retrospective, quasi-experimental study Setting and country: Tertiary, acacdemic medical centre, Boston, USA Study period extende from May 2015 – April 2017 Funding and conflicts of interest: No conflicts of interest declared No specific grant declared |
Inclusion criteria: Nursing units operating for at least 1 month prior to and 1 month after implementation of the policy change Exclusion criteria: Not fulfilling inclusion criteria or haematology/oncology, psychiatry, obstetrics and neonatal units. N total at baseline: Groups comparable at baseline? Yes |
Describe intervention (treatment/procedure/test): Discontinuation contact precautions – only hand hygiene and PPE for encounters with potential exposure to bodily fluids/or non-intact skin |
Describe control (treatment/procedure/test): Standard contact precautions |
Length of follow-up: 1 year Loss-to-follow-up: Not applicable Incomplete outcome data: No incomplete outcome data |
Outcome measures and effect size (include 95%CI and p-value if available): Patient falls and nosocomial pressure ulcers: IRR 0.88 (95% CI: 0.65-1.19) Nosocomial MRSA 1.58 (95% CI: 0.82-3.04) |
The authors conclude that DcCP was associated with an increase in bed availability and revenue recovery, and a reduction in PPE expenditures. Benefits for other hospital operations metrics and patient outcomes were not identified. |
| Hetem (2013) | Type of study: Cohort study Setting and country: Netherlands, hospital Funding and conflicts of interest: No conflicts of interest reported Study is supported by The Netherlands Organization of Scientific Research |
Inclusion criteria: Medical microbiologists and infection control practitioners in all 91 hospitals in the Netherlands were contacted and asked to collect data concerning MRSA outbreaks and the results of subsequent contact screening retrospectively during June–August 2011 and prospectively during September– November 2011 Exclusion criteria: Not fulfilling inclusion criteria N total at baseline: N=141 MRSA index patients N=47 secondary case patients Groups comparable at baseline? yes |
Describe intervention (treatment/procedure/test): Spa typing of MRSA-positive index patients |
Describe control (treatment/procedure/test): Spa typing of MRSA-positive secondary cases. |
Length of follow-up: Not applicable Loss-to-follow-up: Not applicable Incomplete outcome data: No incomplete outcome data. |
Outcome measures and effect size (include 95%CI and p-value if available): Transmission: Index patient (n=141) LA-MRSA: n=40 (28.4%) Other MRSA: n=101 (71.6%) Secondary case patients (n=47) LA-MRSA: n=3 (6.4%) Other MRSA: n=44 (94.6%) RR=0.09 (95% CI 0.04 to 0.24). Discharge rate LA-MRSA 1/13 days Other MRSA: 1/10 days |
The authors conclude that the lower transmissibility of LA-MRSA provide evidence that preemptive isolation may not be necessary for LA-MRSA, which would substantially enhance the feasibility of the current search and destroy policy |
| Omland (2012) | Type of study: Cohort study Setting and country: Denmark, hospital Funding and conflicts of interest: Not reported |
Inclusion criteria: All incident cases of MRSA carriage and infection reported in the period January 2008 – December 2009 to the National Centre for Antimicrobial and Infectious Control, Statens Serum Institut, Copenhagen, from North Denmark Region Exclusion criteria: Not fulfilling inclusion criteria N total at baseline: N=109 MRSA mean age (range): 37.1 years (range 0.3-91years) Status: Carrier status: n=52 Infection status: n=56 Unknown status: n=1 Groups comparable at baseline? yes |
Describe intervention (treatment/procedure/test): Spa typing of LA-MRSA-positive patients |
Describe control (treatment/procedure/test): Spa typing of other MRSA-positive patients |
Length of follow-up: Not applicable Loss-to-follow-up: Not applicable Incomplete outcome data: No incomplete outcome data. |
Outcome measures and effect size (include 95%CI and p-value if available): MRSA infection: LA-MRSA: 8/26 cases Other MRSA: 48/83 cases RR=0.53 (95% CI 0.29 to 0.97). |
The authors conclude that the presented population-based retrospective study shows an infectious potential of CC398 in humans. |
| Wassenberg (2011) | Type of study: Cohort study Setting and country: Netherlands, hospital Funding and conflicts of interest: Authors report conflict of interest for receiving fees from 3M, Destiny Pharma, Novabay and Wyeth, Becton Dickinson. Ipsat therapies, Cepheid, Novartis, Bayer, Kimberly Clark and Pfizer. |
Inclusion criteria: All patients and HCWs who had been screened for MRSA after exposure to MRSA index patients from July 2006 to October 2006 (3 months retrospectively) and from October 2006 to January 2007 (3 months prospectively) Exclusion criteria: Not fulfilling inclusion criteria N total at baseline: n=174 MRSA index cases Clinical screening: n=7892 Outpatient screening: n=507 Groups comparable at baseline? yes |
Describe intervention (treatment/procedure/test): Spa typing of ST398 positive isolates |
Describe control (treatment/procedure/test): Spa typing of other MRSA isolates |
Length of follow-up: Not applicable Loss-to-follow-up: Not applicable Incomplete outcome data: No incomplete outcome data. |
Outcome measures and effect size (include 95%CI and p-value if available): Transmission: ST398:3/1147 Other MRSA:62/6745 RR= 0.28 (95%CI 0.09-0.90). Duration of hospital stay (days): ST398:94 (median: 1.5) Other MRSA: 489 (median: 4.0) |
The authors conclude that nosocomial transmission of ST398 MRSA to HCWs and patients is 72% less likely than that of non-ST398 MRSA strains. |
| Wulf (2012) | Type of study: Cohort study Setting and country: Netherlands, hospital Funding and conflicts of interest: Not reported. |
Inclusion criteria: all MRSA positive cultures from the laboratory system between July 2002 and December 2008 were included Exclusion criteria: Not fulfilling inclusion criteria N total at baseline: n=612 isolates Groups comparable at baseline? yes |
Describe intervention (treatment/procedure/test): Spa typing of ST398 positive isolates |
Describe control (treatment/procedure/test): Spa typing of other MRSA isolates |
Length of follow-up: Not applicable Loss-to-follow-up: Not applicable Incomplete outcome data: No incomplete outcome data. |
Outcome measures and effect size (include 95%CI and p-value if available): MRSA infection: ST398:30/292 Other MRSA:50/323 RR= 0.49 (95% CI 0.32 to 0.76).. |
The authors conclude that the emergence of MRSA ST398 led to an increase in MRSA infections. |