title: Controlling a multicenter outbreak involving the New York/Japan methicillin-resistant Staphylococcus aureus clone.
abstract: OBJECTIVE
  To describe the control of an outbreak of infection and colonization with the New York/Japan methicillin-resistant Staphylococcus aureus (MRSA) clone in multiple healthcare facilities, and to demonstrate the importance of making an MRSA management policy involving molecular typing of MRSA into a statewide public health responsibility.
  
  
  METHODS
  A range of healthcare facilities, including 2 metropolitan teaching hospitals and a regional hospital, as well as several community hospitals and long-term care facilities in a nonmetropolitan healthcare region.
  
  
  METHODS
  A comprehensive, statewide MRSA epidemiological investigation and management policy.
  
  
  RESULTS
  In May 2005, there were 3 isolates referred to the Western Australian Gram-Positive Bacteria Typing and Research Unit that were identified as the New York/Japan MRSA clone, a pandemic MRSA clone with the ability to spread and replace existing clones in a region. Subsequent investigation identified 28 additional cases of infection and/or colonization dating from 2002 onward, including 1 involving a colonized healthcare worker (HCW) who had previously been hospitalized overseas. Of the 31 isolates detected, 25 were linked epidemiologically and via molecular typing to the isolate recovered from the colonized HCW. Four isolates appeared to have been introduced separately from overseas. Although the isolate from the single remaining case patient was genetically indistinct from the isolates that spread within Western Australia, no specific epidemiological link could be established. The application of standard outbreak management strategies reduced further spread.
  
  
  CONCLUSIONS
  The elimination of the New/York Japan MRSA clone in a healthcare region demonstrates the importance of incorporating MRSA management policy into statewide public health programs. The mainstays of such programs should include a comprehensive and effective outbreak identification and management policy (including pre-employment screening of HCWs, where applicable) and MRSA clone identification by multilocus sequence typing.
authors.affiliation: Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine, Western ustralia, Royal Perth Hospital, Perth, Australia. geoffrey.coombs@health.wa.gov.au
authors.forename: G W
authors.initials: GW
authors.lastname: Coombs
authors.forename: H
authors.initials: H
authors.lastname: Van Gessel
authors.forename: J C
authors.initials: JC
authors.lastname: Pearson
authors.forename: M-R
authors.initials: MR
authors.lastname: Godsell
authors.forename: F G
authors.initials: FG
authors.lastname: O'Brien
authors.forename: K J
authors.initials: KJ
authors.lastname: Christiansen
mesh_terms: D015373:Bacterial Typing Techniques; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D016106:Methicillin Resistance; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000145:classification* / Q000302:isolation & purification; D014904:Western Australia / Q000453:epidemiology