title: Prevention of meticillin-resistant Staphylococcus aureus bloodstream infections in European hospitals: moving beyond policies.
abstract: BACKGROUND
  There is evidence that meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia can be reduced with improved infection control and antibiotic stewardship.
  
  
  OBJECTIVE
  To survey infection control and antibiotic stewardship practices within European hospitals and to identify initiatives that correlate with reduced MRSA prevalence.
  
  
  METHODS
  Online questionnaires were sent to European hospitals about their surveillance, hand hygiene, intravenous device management, admission screening, isolation, antibiotic prescribing, hospital demographics and MRSA blood culture isolates during 2010.
  
  
  RESULTS
  In all, 269 replies were received from hospitals in 29 European countries. Lower MRSA prevalence showed significant association with presence of incidence surveillance, performance of root cause analysis, mandatory training requirements for hand hygiene, accountability measures for persistent non-compliance, and multi-stakeholder teamwork in antibiotic prescribing. Presence of policies on intravenous catheter insertion and management showed no variation between different MRSA prevalence groups. However, low-prevalence hospitals reported more competency assessment programmes in insertion and maintenance of peripheral and central venous catheters. Hospitals from the UK and Ireland reported the highest uptake of infection control and antibiotic stewardship practices that were significantly associated with low MRSA prevalence, whereas Southern European hospitals exhibited the lowest. In multiple regression analysis, isolation of high-risk patients, performance of root cause analysis, obligatory training for nurses in hand hygiene, and undertaking joint ward rounds including microbiologists and infectious disease physicians remained significantly associated with lower MRSA prevalence.
  
  
  CONCLUSIONS
  Proactive infection control and antibiotic stewardship initiatives that instilled accountability, ownership, teamwork, and validated competence among healthcare workers were associated with improved MRSA outcomes.
authors: Mater Dei Hospital and University of Malta, Msida, Malta. Electronic address: michael.a.borg@gov.mt.
authors: M A
authors: MA
authors: Borg
authors: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors: M
authors: M
authors: Hulscher
authors: Mater Dei Hospital, Msida, Malta.
authors: E A
authors: EA
authors: Scicluna
authors: International Federation of Infection Control, Norwich, UK.
authors: J
authors: J
authors: Richards
authors: Public Health Specialist, Paris, France.
authors: J-M
authors: JM
authors: Azanowsky
authors: Mater Dei Hospital, Msida, Malta.
authors: D
authors: D
authors: Xuereb
authors: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors: A
authors: A
authors: Huis
authors: Agenzia Sanitaria e Sociale Regione, Emilia-Romagna, Bologna, Italy.
authors: M L
authors: ML
authors: Moro
authors: Hellenic Center for Disease Control and Prevention, Athens, Greece.
authors: H C
authors: HC
authors: Maltezou
authors: Freiburg University Hospital, Freiburg, Germany.
authors: U
authors: U
authors: Frank
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000592:standards*; D005060:Europe; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: Competency; Culture; Infection control; Root cause analysis; Survey