title: Rapid control of a methicillin resistant Staphylococcus aureus (MRSA) outbreak in a medical surgical intensive care unit (ICU).
abstract: BACKGROUND
  Outbreaks of methicillin resistant Staphylococcus aureus in the intensive care unit setting can be prolonged and difficult to control. This report describes the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a 24-bed open-concept medical surgical intensive care unit with a baseline methicillin resistant Staphylococcus aureus acquisition rate of 1.5 cases per 1000 patient days.
  This institution's infection control policy mandates an outbreak investigation if two cases of hospital-acquired methicillin resistant Staphylococcus aureus colonization or infection are identified in an intensive care unit within a four-week period. In July 2007, methicillin resistant Staphylococcus aureus was identified in the sputum of two patients within a one-week period. Screening of all patients in the intensive care unit identified one additional case and a fourth case was identified from a clinical specimen before control measures were implemented. Initial control measures included healthcare worker education, enhanced surveillance, patient cohorting, and enhanced environmental cleaning. Despite these measures, three more cases occurred. All patients were then placed in contact isolation, healthcare workers were screened, and the nursing staff was cohorted. After two weeks without a case, two additional cases were identified. Decolonization of all positive patients was initiated. No further cases occurred over a five-week period and the outbreak was declared over. The outbreak resulted in nine cases of methicillin resistant Staphylococcus aureus colonization (n = 8) or infection (n = 1) over an 11-week period. Only one of 175 healthcare workers was colonized and it was not the outbreak strain.
  
  
  CONCLUSIONS
  Early detection and the stepwise addition of infection control measures resulted in the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a medical surgical intensive care unit without unit closure. A low threshold of suspicion and the rapid initiation of unit wide surveillance were the key steps in limiting the size of the outbreak. Complete cessation of transmission occurred after the initiation of decolonization for all positive patients.
authors.affiliation: St. Michael's Hospital, Toronto, Ontario, Canada. khana@smh.toronto.on.ca
authors.forename: Anjum
authors.initials: A
authors.lastname: Khan
authors.forename: Marianita
authors.initials: M
authors.lastname: Lampitoc
authors.forename: Maryam
authors.initials: M
authors.lastname: Salaripour
authors.forename: Patricia
authors.initials: P
authors.lastname: McKernan
authors.forename: Roslyn
authors.initials: R
authors.lastname: Devlin
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Muller
mesh_terms: D002170:Canada / Q000453:epidemiology; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control*; D052918:Environmental Restoration and Remediation; D006282:Health Personnel / Q000193:education; D006801:Humans; D017053:Infection Control; D008403:Mass Screening; D055624:Methicillin-Resistant Staphylococcus aureus; D010356:Patient Isolation; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*