title: Minimal intervention for controlling nosocomial transmission of methicillin-resistant staphylococcus aureus in resource limited setting with high endemicity.
abstract: OBJECTIVE
  To control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in resource-limited healthcare setting with high endemicity.
  
  
  METHODS
  Three phases of infection control interventions were implemented in a University-affiliated hospital between 1-January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per-1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model). Usage density of broad-spectrum antibiotics was monitored.
  
  
  RESULTS
  During the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3%) were hospital-acquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001), 30.4% (p<0.001), and 19.6% (p = 0.040), while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001), 24.1% (p<0.001), and 21.9% (p = 0.041) respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1) to 168.99 per 1000 patient-days (phase 3).
  
  
  CONCLUSIONS
  Nosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing for MRSA-positive despite an increasing consumption of broad-spectrum antibiotics.
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors.forename: Vincent Chi-Chung
authors.initials: VC
authors.lastname: Cheng
authors.affiliation: Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors.forename: Josepha Wai-Ming
authors.initials: JW
authors.lastname: Tai
authors.affiliation: School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Pui-Hing
authors.initials: PH
authors.lastname: Chau
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors.forename: Jonathan Hon-Kwan
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors.forename: Mei-Kum
authors.initials: MK
authors.lastname: Yan
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors.forename: Simon Yung-Chun
authors.initials: SY
authors.lastname: So
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Kelvin Kai-Wang
authors.initials: KK
authors.lastname: To
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Jasper Fuk-Woo
authors.initials: JF
authors.lastname: Chan
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
authors.forename: Sally Cheuk-Ying
authors.initials: SC
authors.lastname: Wong
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Pak-Leung
authors.initials: PL
authors.lastname: Ho
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission*; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000502:physiology*; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission*; D055815:Young Adult