title: [Strategy to control methicillin-resistant Staphylococcus aureus: the 5 year experience of a hospital].
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus remains one of the principal resistant pathogens causing serious healthcareassociated infections. The objective of this study was to control and monitor methicillin-resistant Staphylococcus aureus cases using multimodal strategy in a Portuguese hospital.
  
  
  METHODS
  Multistep procedure involving isolation measures and active surveillance cultures in a selected population (patients from other hospitals and nursing homes; history of hospitalization/ methicillin-resistant Staphylococcus aureus; intensive and intermediate care patients and, in other inpatient services, direct contacts of newly detected methicillin-resistant Staphylococcus aureus patients and, since 2012, patients doing hemodialysis). Other parallel activities: (a) review of isolation and standard precautions policy, (b) reinforcement of alcohol-based handrubs at point of patient care, (c) information sessions to health professionals, (d) targeted information flyer for health professionals, (e) information leaflet for patients/ visitors; (f) procedure monitoring by audit (g) patient decolonization in intensive and intermediate care units, with follow-up screenings.
  
  
  RESULTS
  Between 2007 and 2012, methicillin-resistant Staphylococcus aureus surveillance detected a decrease in proportion from 66% to 57% and, in density of incidence, from 1.80 to 0.68 cases per thousand days of hospitalization (p < 0.001; RR 0.38; CI95%: 0.29-0.49).
  
  
  CONCLUSIONS
  According to published European data, using blood and cerebrospinal fluid isolates only, Portugal was the country with the highest level of methicillin-resistant Staphylococcus aureus in 2011. Using this inclusion criteria, our hospital reveled a proportion of methicillin-resistant Staphylococcus aureus below its national level (34% versus 55%) in 2011. Fighting methicillinresistant Staphylococcus aureus using a multimodal strategy is being effective in a high endemic level hospital, but perseverance is needed through continuous surveillance of cases, feed-back to professionals and procedure audits.
authors.affiliation: Comissão de Controlo de Infeção. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal.. david.r.peres@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Peres
authors.affiliation: Comissão de Controlo de Infeção. Unidade Local de Saúde de Matosinhos. Matosinhos. & Serviço de Infeciologia. Unidade Local de Saúde de Matosinhos. Matosinhos. & Comissão de Antimicrobianos. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Neves
authors.affiliation: Comissão de Controlo de Infeção. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal.. david.r.peres@gmail.com.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Vieira
authors.affiliation: Comissão de Controlo de Infeção. Unidade Local de Saúde de Matosinhos. Matosinhos. Portugal.. david.r.peres@gmail.com.
authors.forename: Ilda
authors.initials: I
authors.lastname: Devesa
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D006761:Hospitals; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013997:Time Factors