5 years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands.
OBJECTIVE
To evaluate the effectiveness of a rigorous search and destroy policy for controlling methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization.


METHODS
Hospital-based observational follow-up study.


METHODS
Erasmus University Medical Center Rotterdam, a 1,200-bed tertiary care center in Rotterdam, the Netherlands.


METHODS
Outbreak control was accomplished by the use of active surveillance cultures for persons at risk, by the preemptive isolation of patients at risk, and by the strict isolation of known MRSA carriers and the eradication of MRSA carriage. For unexpected cases of MRSA colonization or infection, patients placed in strict isolation or contact isolation and healthcare workers (HCWs) were screened. We collected data from 2000-2004.


RESULTS
During the 5-year study period, 51,907 MRSA screening cultures were performed for 21,598 persons at risk (8,403 patients and 13,195 HCWs). By screening, it was determined that 123 (1.5%) of 8,403 patients and 31 (0.2%) of 13,195 HCWs were MRSA carriers. From the performance of clinical cultures, it was determined that 54 additional patients were MRSA carriers, resulting in a total of 177 patients carrying MRSA. Of the 177 patients carrying MRSA, 144 (81%) were primary patients, and 33 (19%) secondary patients. The average number of nosocomial transmissions was 6.7 per year. The cumulative incidence of MRSA colonization among this group of patients was 0.10 cases per 100 admissions. Of 156 cases of MRSA colonization, 44 (28%) were acquired in a foreign healthcare institution, and 45 (29%) were acquired in other Dutch hospitals, 22 (47%) of which were acquired in a single hospital in our region. There were 16 cases (10%) that occurred in a nursing home and another 16 cases (10%) that fulfilled our definition of community-acquired MRSA colonization; there were 4 cases (3%) categorized as "other" and 31 cases (20%) for which the source of MRSA acquisition remained unknown. The basic reproduction rate was 10-fold less for patients isolated on admission, compared with those who were not. During the 5-year study period, 5 episodes of MRSA bacteremia occurred in which 4 patients died, an incidence rate of 0.28 cases of infection per 100,000 patient-days per year.


CONCLUSIONS
Our results show that, during a rigorous search and destroy policy, a low incidence of MRSA in our medical center was continuously observed and that this policy most likely contributed to a very low nosocomial transmission rate.
Vos
Margreet C
MC
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, the Netherlands. m.vos@erasmusmc.nl
Behrendt
Myra D
MD
Melles
Damian C
DC
Mollema
Femke P N
FP
de Groot
Woutrinus
W
Parlevliet
Gerard
G
Ott
Alewijn
A
Horst-Kreft
Deborah
D
van Belkum
Alex
A
Verbrugh
Henri A
HA
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003470:Culture Media; D004196:Disease Outbreaks / Q000517:prevention & control*; D006282:Health Personnel; D006291:Health Policy; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008403:Mass Screening / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D009426:Netherlands / Q000453:epidemiology; D010356:Patient Isolation; D015397:Program Evaluation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control
D003470:Culture Media