title: Successful reduction of hospital-acquired methicillin-resistant Staphylococcus aureus in a urology ward: a 10-year study.
abstract: BACKGROUND
  To eradicate hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) using a stepwise infection control strategy that includes an avoidance of antimicrobial prophylaxis (AMP) based on surgical wound classification and an improvement in operative procedures in gasless single-port urologic surgery.
  
  
  METHODS
  The study was conducted at an 801-bed university hospital. Since 2001, in the urology ward, we have introduced the stepwise infection control strategy. In 2007, surveillance cultures for MRSA in all urological patients were commenced. The annual incidence of MRSA was calculated as a total number of newly identified MRSA cases per 1,000 patient days. Trend analysis was performed using a Poisson regression.
  
  
  RESULTS
  Over the study period, 139,866 patients, including 10,201 urology patients, were admitted to our hospital. Of these patients, 3,719 patients, including 134 ones in the urology ward, were diagnosed with MRSA throughout the entire hospital. Although the incidence of MRSA increased throughout the entire hospital (p = 0.002), it decreased significantly in the urology ward (p < 0.0001). Of the 134 cases, 45 (33.6%) were classified as "imported," and 89 (66.4%) as "acquired." In the urology ward, the incidence of acquired MRSA decreased significantly over time (p < 0.0001), whereas the incidence of imported MRSA did not change over time (p = 0.66). A significant decrease (p < 0.0001) in the incidence of clinically significant MRSA infection over time was found.
  
  
  CONCLUSIONS
  Stepwise infection control strategy that includes a reduction or avoidance of antimicrobial prophylaxis in minimally invasive surgery can contribute to a reduction in hospital-acquired MRSA.
  
  
  BACKGROUND
  Current study has approved by the institutional ethical review board (No.1141).
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Tatokoro
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Masaya
authors.initials: M
authors.lastname: Ito
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kijima
authors.forename: Minato
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data*; D014572:Urology / Q000706:statistics & numerical data*; D055815:Young Adult