Importance of Multifaceted Approaches in Infection Control: A Practical Experience from an Outbreak Investigation.
BACKGROUND
This study presents the results of a multidisciplinary, nosocomial MRSA outbreak investigation in an 8-bed medical intensive care unit (ICU). The identification of seven MRSA positive patients in the beginning of 2014 led to the closure of the ward for several weeks. A multidisciplinary, retrospective investigation was initiated in order to identify the reason and the source for the outbreak, describe MRSA transmission in the department and identify limitations in infection control.


METHODS
The investigation comprised an epidemiological description of MRSA cases from 2012 to 2014 and a characterization of MRSA isolates, including phage-, spa- and PFGE-typing. Additionally, MRSA screening was performed from the hospital staff and the environment. To identify the reason for the outbreak, work-related, psychological and behavioral factors were investigated by impartial audits and staff interviews.


RESULTS
Thirty-one MRSA cases were registered during the study period, and 36 isolates were investigated. Molecular typing determined the outbreak strain (phage type 54/812, PFGE type A4, spa type t003) and identified the probable index case. Nasal carriage in one employee and a high environmental contamination with the outbreak strain was documented. Important gaps in nursing procedures and general management were identified. Elevated stress levels and communication problems preceded the outbreak. Compliance with hand hygiene and isolation procedures was evaluated as appropriate.


CONCLUSIONS
This study demonstrates the complexity of controlling hospital-associated infections. The combined use of different typing methods is beneficial for outbreak investigations. Psychological, behavioral and other work-related factors have an important impact on the spread of nosocomial pathogens. These factors should be addressed and integrated in routine infection control practice.
National Institute of Public Health (NIPH), Prague, Czech Republic.|European Program for Public Health Microbiology (EUPHEM), ECDC, Stockholm, Sweden.
Nina Katharina
http://orcid.org/0000-0002-5039-0778
NK
Stock
National Institute of Public Health (NIPH), Prague, Czech Republic.
Petr
P
Petráš
Department of Medical Microbiology, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic.
Oto
O
Melter
Department of Clinical Microbiology and Antibiotic Centre, Na Homolce Hospital, Prague, Czech Republic.
Gabriela
G
Kapounová
Department of Clinical Microbiology and Antibiotic Centre, Na Homolce Hospital, Prague, Czech Republic.
Petra
P
Vopalková
Department of Clinical Microbiology and Antibiotic Centre, Na Homolce Hospital, Prague, Czech Republic.
Jan
J
Kubele
National Institute of Public Health (NIPH), Prague, Czech Republic.|Department of Clinical Microbiology and Antibiotic Centre, Na Homolce Hospital, Prague, Czech Republic.
Václav
V
Vaniš
Department of Medical Microbiology, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic.
Jan
J
Tkadlec
Department of Medical Microbiology, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic.
Eva
E
Bukáčková
National Institute of Public Health (NIPH), Prague, Czech Republic.
Ivana
I
Machová
National Institute of Public Health (NIPH), Prague, Czech Republic.
Vlastimil
V
Jindrák
D001519:Behavior; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification / Q000502:physiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D011795:Surveys and Questionnaires; D014937:Work / Q000523:psychology