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Nosocomial Methycillin-resistant Staphylococcus aureus Remained Stable During SARS Outbreak: Presented at ICAAC

By Paula Moyer

WASHINGTON, DC -- November 1, 2004 -- The transmission rate of methycillin-resistant Staphylococcus aureus (MRSA) within hospitals did not decline significantly in several Toronto hospitals during the 2003 outbreak of severe acute respiratory syndrome (SARS), and actually increased in 1.

Principal investigator Susan M. Poutanen, MD, MPH, microbiologist and infectious disease consultant, Toronto Medical Laboratories, and Mount Sinai Hospital, Toronto, Ontario, Canada, presented data on intrahospital SARS transmission here on October 30th at the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy.

Her research team surveyed 4 Toronto hospitals and determined their rates of monthly nosocomial MRSA acquisition per 1,000 admissions and per 10,000 patient-days. Among the 4 facilities, 3 were tertiary-care centers with approximately 2,200-bed capacity among them, and a 430-bed community hospital. Among the facilities, there were 155 SARS patients.

The investigators wanted to see if the routine use of personal protective equipment (PPE), which was mandated in April 2003 during the SARS outbreak in Toronto, was linked to a decrease in nosocomial transmission of MRSA. Standard PPE included eye protection, masks, gloves, and gowns.

The study design included only newly identified patients, and the investigators counted each patient once. The investigators then compared the rates for April 2003 with those for the previous 14 months and the following 6 months. They used a Poisson regression analysis to compare the data.

The results show a decrease in nosocomial MRSA during April 2003 from the previous 14 months in 3 of the 4 hospitals (P >.05). In the 6-month period after the targeted month, the rates were slightly up for 2 hospitals; while in the other 2 hospitals, the rate was down in that period. However, the differences among the 4 in the postoutbreak period were not statistically significant, and no facility eliminated transmission altogether.

Dr. Poutanen reported that, in areas of the hospitals without SARS inpatients, some observers reported that several staff in all 4 facilities failed to change gowns and gloves between patients during the outbreak. This lack of adherence to proper use of PPE may have aided the transmission of MRSA, she said.

According to Dr. Poutanen, the research team had expected to find a reduction in MRSA spread due to the mandated use of universal contact and enhanced droplet precautions.

"The lack of decrease seems to be due to poor implementation of these precautions," she said. "In addition to mandating these precautions, hospitals also need to educate staff about the rationale for them. The precautions are not just to protect staff, but to protect patients."

For example, she noted that in the 1 hospital that had an increase in MRSA transmission, the hospital had an education campaign after the SARS outbreak to explain the reason for the precautions and how to follow them properly. After the education campaign, the MRSA infection rate declined.

"It's not enough to mandate universal contact and droplet precautions," she said. "Staff may need additional training to understand the reasoning for the precautions, and they may need ways to help them remember to change barriers between patients." For example, if one is required to take gowns and gloves off after leaving a hospital room, it may be easier to note that those barriers are missing and to don fresh ones when entering a patient's room, she said.


[Presentation title: Nosocomial Acquisition of Methicillin-Resistant Staphylococcus aureus (MRSA) during an Outbreak of Severe Acute Respiratory Syndrome (SARS). Abstract K-85]

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