New guidelines to stem the tide of MRSA spread in hospitals

During the COVID pandemic, methicillin resistants Staphylococcus aureus (MRSA) in acute care hospitals has risen sharply, despite a decrease in infections before the pandemic, the Society for Healthcare Epidemiology of America (SHEA) said in its latest guidelines.

“It is unclear whether the decline in the use of contact precautions for patients colonized with MRSA or infected with MRSA played a significant role in this increase,” noted David Calfee, MD, of Weill Cornell Medical College. in New York, and his colleagues from Infection control and hospital epidemiology.

About 10% of infections in US hospitals are due to MRSA, according to the authors. During the first year of the pandemic, progress against deadly antimicrobial resistant infections has reversedaccording to CDC data.

“The enormous strain on health care during the pandemic may have contributed to the observed increase in some hospital infections. We have data that shows MRSA infections have increased,” Calfee said in a press release. published by SHEA.

In the updated guidelines, Calfee and co-authors recommended active surveillance to detect asymptomatic MRSA, particularly among certain vulnerable patient populations, noting that patients should be assessed on an ongoing basis, particularly if hospital precautions have been modified or are in the process of being modified. In the process of being modified.

The bacteria that cause MRSA infection are resistant to many antibiotics used to treat common staph infections. MRSA infections are commonly seen after surgery or after using hospital equipment such as central venous catheters. The bacteria is easily spread in hospitals by patients, healthcare providers, equipment and contaminated surfaces.

For all recommendations, the authors reviewed the quality of the evidence. Recommendations considered to have moderate or high quality evidence and recommended as essential practices included:

• Promote compliance with CDC or World Health Organization (WHO) hand hygiene recommendations
• Use contact precautions for MRSA-colonized and MRSA-infected patients (and assess if they are effective)
• Ensure the cleaning and disinfection of equipment and the environment

Additional approaches with moderate or high quality evidence include:

• Implementation of an active MRSA surveillance testing program for selected patient populations as part of a multi-faceted strategy to control and prevent MRSA
• Active MRSA surveillance in conjunction with decolonization of target populations prior to surgery to prevent post-surgical MRSA infection
• Active hospital-wide surveillance for MRSA in conjunction with contact precautions to reduce the incidence of MRSA infection

“Routine infection prevention practices, such as hand hygiene and cleaning and disinfecting the environment and healthcare equipment, remain fundamental to preventing MRSA,” Calfee said in the release. press. “These basic practices also help prevent the spread of other pathogens.”

Contact precautions and the use of gowns and gloves when treating a patient with MRSA colonization or infection remain a core practice in the new guidelines.

“The evidence that informs these recommendations shows that we can successfully prevent transmission and infection,” he added. “We can get back to pre-2020 rates and do even better.”

Despite its low-quality evidence, the guidelines note that “an antimicrobial stewardship program is an important component of many quality and safety endpoints, including the prevention of MRSA,” adding that patients receiving antibiotic treatment for another infection may be at higher risk of developing MRSA. infection and pass it on to other susceptible patients.

The authors also noted that active surveillance with contact precautions is inferior to universal decolonization for reducing clinical MRSA isolates in adult intensive care units.

The authors of the guidelines, last updated in 2014, assessed the literature from January 2012 to August 2021. Representatives from SHEA, Infectious Diseases Society of America, Association for Professionals in Infection Control and Epidemiology, American Hospital Association, Joint Commission, and CDC were on the panel. Group members reviewed and endorsed the document and its recommendations.