HEALTHCARE-ASSOCIATED MRSA Emerging Problems Clinical Patterns Strategies for Control Ed Septimus,...

HEALTHCARE-ASSOCIATEDMRSA

Emerging ProblemsClinical PatternsStrategies for Control

Ed Septimus, MD, FACP, FIDSA, [email protected]

Emerging Problems with S. aureusIncreasing proportion of healthcare-associated S. aureus infections due to MRSA.Increasing prevalence of MRSA among community onset infections leading introduction into the healthcare system.Reports of S. aureus strains with reduced susceptibility to vancomycin (VISA) and VRSA~30% of newly acquired MRSA carriers develop invasive disease which can be more severe

How often do colonized patients lead to infection?19% of patients colonized with MRSA at admission develop an infection1For patients that acquire MRSA within the hospital, 25% develop an infection129% of MRSA positive patients became infected within 18 months23.95 MRSA infections estimated per 1000 discharges30.8 MRSA infections estimated per 1000 patient days41. Davis KA et.al. CID 2004;39:776-82 2. Huang & Platt, CID 2003;36:2813. Kuehnert MJ et.al. EID 2005;11:868-72 4. Cooper BS et.al. Health Technol Assess. 2003;7(39):1-194

Emerging Problems-continuedIncreasing resistance to mupirocin.Frequent failure of decolonization protocols.Decreased efficacy of vancomycin for the treatment of serious MRSA infections compared with an anti- staphylococcal penicillin for MSSA.Isolation of linezolid resistant isolates of MRSA and decreased susceptibility to daptomycin

Hospitalization and Deaths Caused by MRSAUS 1999-2005Emerg Infect Dis 2007; 13:1840

Incidence of Invasive CA-MRSA Infections and Deaths by AgeActive Bacterial Core surveillance (ABCS), 2005Incidence per 100,000 personsKlevens et al JAMA 2007;298:1763-71Overall Incidence (all ages):Infections: 31.8 per 100,000Deaths: 6.3 per 100,000

ID RatesInvasive MRSA31.8/100,000 people

Invasive pneumococcal disease14.1/100,000 people

Invasive group A strep 3.6/100,000 people

Invasive meningococcal disease 0.35/100,000 people

APIC National MRSA Inpatient SurveyAJIC 2007; 35:631

Infections Due to Community- and Healthcare-Associated MRSAPrevalence of MRSA increasing in hospitals and in the community11. McDonald LC. Clin Infect Dis. 2006;42:S65-S71. 2. Naimi TS, et al. JAMA. 2003;290:2976-2984.

Adverse Outcomes Associated With MRSA Infection Kaye K, et al. Emerg Infect Dis. 2004;10:1125-1128.a OR = 3.4 P = .003; b ME = 1.2, P = .11; c ME = 1.2 P = .03.OR = odds ratio; ME = multiplicative effect.Substantial mortality and costs associated with surgical site infections caused by MRSAabc(n = 121) (n = 165)MRSAMSSA0510152025Mean Length of StayDays020406080100120140Mean Charges$1000

Most Invasive MRSA Infections Are Healthcare-AssociatedKlevens et al JAMA 2007;298:1763-7114%86%

Classification of Invasive MRSA Infections Classification Definition

Health care-associated Cases with at least 1 of the following risk community-onset (HCA) factors: (1) presence of an invasive device on admit; (2) history of MRSA infection or colonization; (3) hx of surgery, hosp, dialysis, or residence of LTC in previous 12 months preceding culture

Hospital-onset (HOI) Cases with positive culture result from a normally sterile site obtained >48 h after hospital admit. Cases may also have 1 of the community-onset risks

Community-associated (CAI) Cases with no documented community-onset health care risk factor

Invasive MRSAJAMA 2007; 298:1763

Distinction Between CA-MRSAand HA-MRSA Is BlurringKlevens RM, et al. Emerg Infect Dis. 2006;12:1991-1993.CA-MRSA strains are emerging in the healthcare setting, while HA-MRSA strains are moving out into the community

Carriage of MRSA among Hospital Employees: Prevalence, Duration, and Transmission to HouseholdsInfect Control Hosp Epidemiol 2004; 25:114MRSA transmission between patients and employees depends on the frequency and duration of exposure to MRSA-positive patients and infection control measures employedTransmission of MRSA from colonized HCWs to their households was documented in 4 of 10 families investigated

The Landscape of Healthcare-Associated (HCA) InfectionsHealthcare system is evolving to an increased use of outpatient procedures and long-term care

Many long-term-care facilities now experience infection rates comparable to those in acute hospital settingsOutbreaks are commonHigh rates of colonization with resistant strains Nicolle LE. Clin Infect Dis. 2000;31:752-756.

Epidemiology MRSAReservoirsHumans are the natural reservoirs for S. aureus. 20-50 % of healthy adults are colonized with S. aureus, and 10-20% are persistent carriers. Colonization rates are highest among patients with type 1 diabetes, IV drug users, hemodialysis, dermatologic conditions, and AIDS. Colonized and infected patients are the major reservoir of MRSA.

Where is the reservoir for MRSA?~10,000 participants in the US, 20012002 Natl. Health and Nutrition Examination Survey32.4% colonized with S. aureus = 89.4 million 0.8% colonized with MRSA = 2.3 million1. Creech et al. J Inf Dis 2006;193:169-719.2% of 500 healthy children screened in 2004 were colonized1

Role of Nasal Carriage inS. aureus InfectionsLancet Infect Dis 2005; 5:751

13-25%

40%

30-39%Frequency of MRSA Colonization at Various Body SitesHill RLR et al. J Antimicrob Chemother 1988;22:377Sanford MD et al. Clin Infect Dis 1994;19:1123

Evaluation of a Strategy of Screening Multiple Anatomic Sites for MRSA at Admission to a Teaching HospitalInfect Control Hosp Epidemiol 2006; 27:181-184Site% Positive

Nares 73 Rectum 47 Axilla 25 Nares+Axilla 83 Nares+Rectum 91

Epidemiology MRSA-continued MRSA has been isolated from environmental surfaces, and can be implicated in transmissionRisk Factors-MRSAHospitalizationGreater than 65 years of ageInvasive proceduresOpen woundsCertain underlying diseases (e.g. DM)Prior antibiotics

MRSA/MSSA Risk after Levofloxacin and Ciprofloxacin ExposureLevofloxacinCiprofloxacinOdds ratios from multivariable analysisOdds ratioWeber et al. Emerg Infect Dis. 2003;9:1415-1422.P < 0.0001P =0.005

PREVENTION OF TRANSMISSION OF MRSA

Reasons Infection Control Measures Have Failed to Control Spread of MRSAFailure to perform active surveillance (iceberg effect)Barrier precautions alone did not address reservoirs and modes of transmission of MRSAPoor adherence to HCWs to barrier precautions and hand washingIncreasing importation of MRSA by patients admitted from extended-care facilities or to other acute care facilities and the communityInadequate antimicrobial stewardshipInadequate environmental cleaning

How is the reservoir for MRSA identified?1. Sources: Eveillard M et.al., J Hosp Infect 2005;59:254 & Salgado CD et.al., SHEA 2003 abstract 28, p.61 2. Bhalla A et.al. Infect Control Hosp Epidemiol 2004;25:164

75-85% of the MRSA reservoir goes unidentified by clinical cultures alone1Colonized patients, not just infected patients, lead to transmission of MRSA2 Clinical microbiology cultures capture the tip of the iceberg

Role of the Environment: Colonized vs. InfectedEnvironmental contamination of patient rooms is the same whether the patient is colonized or infected (~ 70%)

Contaminated surfaces include patients gowns, floor, bed linens, blood pressure cuffs, overbed tables, etc.

Boyce, ICHE 1997; 18:622 Reisner et al., ICHE 2000; 21:775

ENVIRONMENTAL SITES POSITIVEFOR MRSA

Percent of Surfaces Positive

Boyce JM et al. Infect Control Hosp Epidemiol 1997;18:622

Importance of the environment in MRSA acquisition: the case for hospital cleaningLancet Infect Dis online Oct 31, 2007

Survival of MRSA/VRE in the EnvironmentDuration of survival of MRSA in dry conditionsPlastic charts = 11 daysLaminated tabletop = 12 daysCloth curtains = 9 days

Environmental survival of VRE50% survival at 7 days on upholstery, furniture and wall coveringsVRE could be transferred easily by touching contaminated surfaces

Huang et al., Infect Control Hosp Epidemiol 2006; 27:1267-69Lankford et al., Am J Infect Control 2006; 34: 258-63

Isolation Gowns

65% of HCWs contaminated their uniforms or gowns during routine care of patients with MRSA

> 25% of the time, HCWs clean hands became recontaminated after contact with their contaminated clothing

Gowns prevented contamination of clothing underneath the gown

Boyce, Infect Control Hosp Epidemiol 1997; 18:622.Boyce, SHEA 1998, Abstract #S74

Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room OccupantsArch Intern Med 2006;166:1945Twenty-month retrospective cohort study of patients admitted to the ICU performing routine admission and weekly screening for MRSA and VREAmong patients whose prior room occupant was MRSA positive, 3.9% acquired MRSA compared with 2.9% of patients whose prior room occupant was MRSA negative (OR 1.4; P=.04) The environment overall was considered a contributor to overall transmission

Percent MRSA Among All Nosocomial Infections 1975 to 1997, by Hospital Bed Size**Adapted from: National Nosocomial Infection Surveillance (NNIS) SystemContact IsolationBody Substance IsolationContact Precautions

adapted from NNIS System data

Percent Handwashing Compliance among HCWsin 34 Observational Studies, 1981-2000Median

Infect Control Hosp Epidemiol 2006;27:245

Hand Hygiene Does Work!

Decreased MRSA in Association With Improved HandwashingAcute and Long Term Care Hospital in IllinoisHospital-wide introduction of wall mounted alcohol-based sinkless hand rub plus educational sessionMRSA rate decrease from 0.9 isolates/1000 patient days to 0.6 isolates/1000 pt days (p=0.002)Vernon MO, et al. IDSA 2001, abstract 249

Adherence to RecommendedBarrier Precautions and HandwashingAmong HCWs Caring for MRSA PatientsObservational survey conducted in a teaching hospital in Canada488 observationsAdherence to MRSA precautionsGloves worn to enter room 65%Gown worn when entering room65%Hand hygiene after glove/gown removal 35%All measures adhered to28%Afif W et al. Am J Infect Control 2002;30:430

Percent of S. aureus Blood Isolates Resistant toAntimicrobials in Denmark, 1960-1995

Source: DANMAP Report, 1997

Dutch Approach to Controlling MRSA

In the Netherlands, a national guideline was developed by a Dutch Working Party on Infection Control, and was adopted nation-wide in 1988.Aggressive, search & destroy strategyPrivate room for MRSA patientsuse of masks, cap, gloves and gown for entering roomPre-emptive Isolation & screening cultures of patients transferred from other countries with endemic MRSAif MRSA case found, screening cultures of patients/HCWsColonized patients and HCWs are treated with mupirocinRestrict use of broad-spectrum antibioticsPrevalence of MRSA has remained < 1% in the Netherlands despite multiple importations from other countries

Verhoef J et al. Eur J Clin Microbiol Infect Dis 1999;18:461

Lancet 2006; 368:874

Efficacy of Contact Precautions in Preventing Transmission of MRSA

Outbreak investigation that included weekly cultures of patients, cultures of personnel, molecular typing of isolates, and decolonization of some patientsRate of MRSA transmissions/day:from patients not in Contact Precautions = 0.14 from patients in Contact Precautions = 0.009relative risk of transmission = 15.6Transmission was reduced 16-fold by Contact Precautions

Jernigan JA et al. Am J Epidemiol 1996;143:496

Intensified Efforts to Control Resistant Pathogens in a Hospital with Endemic MRSA and VRE

University hospital found that current control measures proved ineffective in controlling endemic MRSA and VREImplemented intensified control measuresweekly screening of high-risk patients in adult and pediatric ICUs and intermediate care unitsanterior nares (and wound if present) cultured for MRSAperirectal cultures obtained for VRECultures on selective media by Infection Control labcolonized/infected patients placed on Contact Precautions

Karchmer TB et al. Annual SHEA meeting, 2003, abstr. 257

Incidence of Colonization Since Initiation of Active Surveillance

Chi-sq for Trend : MRSA p = 0.003, VRE p < 0.0001

incidence by 4 week interva (2)

0.05149051490.0680100756

0.07386363640.056122449

0.03307888040.0263157895

0.04176334110.0307017544

0.03601108030.0366492147

0.02272727270.0330969267

0.01860465120.0202247191

0.03970223330.0138568129

0.02678571430.0187891441

Time frame = 4/23/02 - 12/17/02

MRSA

VRE

4-week intervals

Percentage per 100 pts at risk

Cases

1412

1122

824

621

1725

932

633

1122

628

524

518

317

New cases or MRSA/VRE

Cases Known to Have MRSA/VRE

Weeks

Number of Cases

Cases of VRE/MRSA by Week since Initiation of Phase II of Active Surveillance

Prevalence_Incidence

0.24528301890.1320754717

0.3084112150.1028037383

0.29357798170.0733944954

0.25714285710.0571428571

0.38181818180.1545454545

0.39423076920.0865384615

0.34821428570.0535714286

0.29464285710.0982142857

0.29565217390.052173913

0.2436974790.0420168067

0.20720720720.045045045

0.17857142860.0267857143

0.20.0461538462

0.250.0606060606

0.28813559320.0762711864

00

0.340.05

0.30476190480.0666666667

0.21818181820.0272727273

0.24299065420.046728972

0.2320.048

0.20535714290.0357142857

0.2035398230.0265486726

0.18867924530.0377358491

0.15254237290.0338983051

0.15929203540.017699115

0.19834710740.041322314

0.17213114750.0327868852

0.20338983050.0423728814

0.23577235770.0487804878

0.27102803740.0373831776

0.1840.016

0.17073170730.0243902439

0.17322834650.031496063

0.17557251910.0381679389

0.1626016260.0406504065

Prevalence of MRSA/VRE

Incidence of New MRSA/VRE

Weeks

Percentage of Cases/ 100 Patients

Prevelance and Incidence of MRSA/VRE

Prevalence of all MRSA

0.1698113208

0.1775700935

0.1926605505

0.1904761905

0.2636363636

0.2692307692

0.2767857143

0.2142857143

0.2086956522

0.2016806723

0.1441441441

0.125

0.1538461538

0.1818181818

0.186440678

0

0.21

0.219047619

0.1363636364

0.1682242991

0.184

0.1607142857

0.1150442478

0.1320754717

0.1271186441

0.1061946903

0.1074380165

0.0983606557

0.1525423729

0.1707317073

0.2336448598

0.144

0.1382113821

0.1338582677

0.1450381679

0.1138211382

0.136

0.1282051282

0.0895522388

0.1015625

0.1349206349

April 23, 2002 - Dec 10, 2002

Prevalence of all MRSA

Weeks

Prevalence

Total Prevalence of MRSA in ICUs and Step-down units

Prevalence of all VRE

0.0943396226

0.1588785047

0.128440367

0.1238095238

0.1818181818

0.1634615385

0.125

0.1339285714

0.1304347826

0.0840336134

0.0990990991

0.0892857143

0.0769230769

0.0984848485

0.1355932203

0.1271186441

0.15

0.1238095238

0.1090909091

0.1214953271

0.072

0.0803571429

0.1238938053

0.0849056604

0.0423728814

0.0707964602

0.1157024793

0.106557377

0.093220339

0.0975609756

0.1214953271

0.08

0.0487804878

0.062992126

0.0534351145

0.0650406504

0.088

0.1025641026

0.1044776119

0.109375

0.119047619

Prevalence of All VRE

Weeks

Cases per 100 patients

Prevalence of all VRE in ICUs and Step-down units

Cummulative data

WeekDatenew MRSAOld MRSAnew VREold VREnew MRVRold MRVRtotal new patientstotal old ptstotal patientsOld MRSA - CxOld VRE - CxOld MRVR - CXTotal OLD ROP with - CX on sweeptotal patients with ROPnumber of patients on the phase II units (or number cultured in week 1 -11)Prevalence from culturestotal prevalence including old ROPIncidence of newly identifiedtotal of previously identified and old ROP with - CxIncidence of MRSAIncidence of VREPrevalence of all MRSAPrevalence of All VREtotal number of cultures done on Phase II unitstotal number of patients cultured

104/23/026570111462051062610618.9%24.5%13.2%125.7%6.6%17.0%9.4%341106estimates for first 3 weeks

204/30/0237662111142562083310723.4%30.8%10.3%222.8%5.6%17.8%15.9%341107

305/07/023854038152372093210921.1%29.4%7.3%242.8%4.6%19.3%12.8%341109

405/14/024525066162250052710521.0%25.7%5.7%213.8%1.9%19.0%12.4%357105

505/21/0297741517163362194211030.0%38.2%15.5%258.2%6.4%26.4%18.2%379110

605/28/0269370391928931134110426.9%39.4%8.7%325.8%2.9%26.9%16.3%359104

706/04/02313350562329901103911225.9%34.8%5.4%332.7%2.7%27.7%12.5%385112

806/11/0267431411142552183311222.3%29.5%9.8%225.4%3.6%21.4%13.4%373112

906/18/023530006511117523341159.6%29.6%5.2%282.6%2.6%20.9%13.0%327115

1006/25/024700105712854172911910.1%24.4%4.2%243.4%0.0%20.2%8.4%330119

1107/02/0234200054955414231118.1%20.7%4.5%182.7%1.8%14.4%9.9%339111

1207/09/0223100033655414201125.4%17.9%2.7%171.8%0.9%12.5%8.9%26678

1307/16/02422000628104418261306.2%20.0%4.6%203.1%1.5%15.4%7.7%30289

1407/23/025230008210136423331327.6%25.0%6.1%253.8%2.3%18.2%9.8%32488estimated number of cultures

1507/30/023250109211137323341189.3%28.8%7.6%252.5%4.2%18.6%13.6%33796estimate number of cultures



1808/20/02611000718128424321057.6%30.5%6.7%255.7%1.0%21.9%12.4%

1908/27/02112000314107320241103.6%21.8%2.7%210.9%1.8%13.6%10.9%

2009/03/02014110527123419261076.5%24.3%4.7%210.0%3.7%16.8%12.1%

2109/10/023330016410143219291258.0%23.2%4.8%232.4%2.4%18.4%7.2%

2209/17/02222001437103316231126.3%20.5%3.6%191.8%1.8%16.1%8.0%

2309/24/0200300030397420231132.7%20.4%2.7%200.0%2.7%11.5%12.4%

2410/01/0230110041584315201064.7%18.9%3.8%162.8%0.9%13.2%8.5%

2510/08/02212000415101213181184.2%15.3%3.4%141.7%1.7%12.7%4.2%

2610/15/0211100021385215181132.7%15.9%1.8%160.9%0.9%10.6%7.1%

2710/22/02401000505610319241214.1%19.8%4.1%193.3%0.8%10.7%11.6%

2810/29/0200410041584416211224.1%17.2%3.3%170.0%3.3%9.8%10.7%

2911/05/02202010505114419241184.2%20.3%4.2%191.7%1.7%15.3%9.3%

3011/12/02511200639115420291237.3%23.6%4.9%234.1%0.8%17.1%9.8%

3111/19/02300010404134825291073.7%27.1%3.7%252.8%0.0%23.4%12.1%

3211/26/02200000202115521231251.6%18.4%1.6%211.6%0.0%14.4%8.0%

3312/03/02320000325104216211234.1%17.1%2.4%182.4%0.0%13.8%4.9%

3412/10/02311001426104216221274.7%17.3%3.1%182.4%0.8%13.4%6.3%

3512/17/02411000516113317231314.6%17.6%3.8%183.1%0.8%14.5%5.3%

3612/31/02203000505103215201234.1%16.3%4.1%151.6%2.4%11.4%6.5%

3701/07/03111020415116219241254.0%19.2%3.2%200.8%0.8%13.6%8.8%

3801/14/0330301070785316231176.0%19.7%6.0%162.6%2.6%12.8%10.3%

3901/21/0321310052789118251345.2%18.7%3.7%201.5%2.2%9.0%10.4%

4001/28/0330300060689219251284.7%19.5%4.7%192.3%2.3%10.2%10.9%

4102/04/032242006410117220301267.9%23.8%4.8%241.6%3.2%13.5%11.9%

4202/11/03000000.0%0.0%0.0%0

4302/18/03

4402/25/03

4503/04/03

4603/11/03

4703/18/03

4803/25/03

4904/01/03

5004/08/03

5104/15/03

5204/22/03

Incidence of all new VRE

0.0849056604

0.0934579439

0.0550458716

0.019047619

0.0909090909

0.0288461538

0.0357142857

0.0446428571

0.0434782609

0.0168067227

0.027027027

0.0089285714

0.0307692308

0.0378787879

0.0423728814

0

0.03

0.019047619

0.0272727273

0.0560747664

0.048

0.0357142857

0.0265486726

0.0094339623

0.0169491525

0.017699115

0.0082644628

0.0327868852

0.0254237288

0.0162601626

0.0093457944

0

0.0162601626

0.0157480315

0.0152671756

0.0243902439

0.032

0.0341880342

0.0298507463

0.0234375

0.0476190476

Phase II Units = adult ICUs, Peds ICUs, and step-down units

(4/23/02 - 2/4/03)

week 34 -upgrade medipacweek 38 - fixed flow to last word

Incidence of VRE in Phase II units

Weeks of Active Surveillance

Incidence per 100 patients

Incidence of VRE on Phase II Units

Incidence of all new MRSA

0.0660377358

0.046728972

0.0275229358

0.0380952381

0.0909090909

0.0576923077

0.0267857143

0.0625

0.0260869565

0.0420168067

0.027027027

0.0178571429

0.0307692308

0.0378787879

0.0423728814

0.0338983051

0.04

0.0571428571

0.0090909091

0.0186915888

0.024

0.0178571429

0

0.0377358491

0.0169491525

0.0088495575

0.0330578512

0.0081967213

0.0254237288

0.0569105691

0.0373831776

0.016

0.0243902439

0.0236220472

0.0305343511

0.0162601626

0.024

0.0341880342

0.0223880597

0.0234375

0.0317460317

Phase II units = adult ICUs, Peds ICUs, and step-down units

Apirl 23, 2002 - Feb 4, 2003

medipac upgrade - week 34, fixed problems from upgrade - week 38

Incidence of New MRSA

Weeks of Active Surveillance

Incidence per 100 Patients

Incidence of MRSA on Phase II Units

Incid New VRE from at risk pt

0.0865384615

0.101010101

0.06

0.0212765957

0.1020408163

0.0333333333

0.0396039604

0.0485436893

0.0485436893

0.0181818182

0.0294117647

0.0097087379

0.0327868852

0.0409836066

0.0458715596

0

0.0344827586

0.0208333333

0.03

0.0606060606

0.0504201681

0.0380952381

0.0294117647

0.0103092784

0.0173913043

0.0186915888

0.0092592593

0.0347826087

0.027027027

0.018018018

0.0104166667

0

0.0170940171

0.0168067227

0.016

0.0254237288

0.0338983051

0.037037037

0.0322580645

0.0254237288

0.052173913

week 34 - medipac upgradeweek - 38 fixed problems related to upgrade4/23/02 - 2/4/03

incidence of VRE

Weeks

Percentage

Incidence of VRE in Phase II units based on patients at risk (not known to be colonized)

Incid new MRSA from at risk pt

0.0736842105

0.0531914894

0.032967033

0.0449438202

0.1098901099

0.0731707317

0.0357142857

0.0736842105

0.0319148936

0.0495049505

0.0306122449

0.02

0.0347826087

0.0431034483

0.05

0.04

0.0476190476

0.0638297872

0.0106382979

0.0224719101

0.0283018868

0.0212765957

0

0.0416666667

0.019047619

0.0097087379

0.0357142857

0.0090909091

0.0291262136

0.0673076923

0.0459770115

0.0183486239

0.027027027

0.0267857143

0.0347826087

0.0181818182

0.0285714286

0.0384615385

0.0243902439

0.0256410256

0.0363636364

week 34 - medipac upgradeweek 38 - corrected problems related to upgrade4/23/02 - 2/4/03

Incidence of MRSA

Weeks

Percentage

Incidence of MRSA on Phase II units based on at risk population (not known to be colonized)

incidence by 4 week interval

0.05149051490.0680100756

0.07386363640.056122449

0.03307888040.0263157895

0.04176334110.0307017544

0.03601108030.0366492147

0.02272727270.0330969267

0.01860465120.0202247191

0.03970223330.0138568129

0.02678571430.0187891441

Time frame = 4/23/02 - 1/31/03

MRSA

VRE

4-week intervals

Percentage per 100 pts at risk

Incidence of MRSA and VRE Colonizations in Phase II Units

ratio_incidence to prevalence

0.38888888890.8181818182

0.27777777780.5555555556

0.14285714290.4

0.20.1538461538

0.34482758620.4545454545

0.21428571430.1764705882

0.09677419350.2666666667

0.29166666670.3571428571

0.1250.2941176471

0.21739130430.1818181818

0.21428571430.25

0.14285714290.1

0.21052631580.3333333333

0.23809523810.3333333333

0.21739130430.3571428571

0.18181818180

0.20.1875

0.35294117650.1818181818

0.05882352940.2307692308

0.10.4285714286

0.13636363640.5

0.10.3636363636

00.2142857143

0.28571428570.1

0.13333333330.4

0.09090909090.25

0.30769230770.0833333333

0.07692307690.3636363636

0.16666666670.3

0.26923076920.1428571429

0.16666666670.0833333333

0.11111111110

0.20.25

0.16666666670.2

0.20.25

0.13333333330.375

MRSA

VRE

Ratio of incidence to prevalence

MRSA_VRE data

VRE dataDATENew VRE or MRVRNew VRE (regardless of previous status)4 week intervals for VREIncidence of VREIncidence for NEW VRE regardless of status with at risk denominatorIncidence for NEW VRE regardless of statusNew MRSANew MRSA (regardless of previous status)Incidence of MRSAIncidence for NEW MRSA regardless of status with at risk denominatorIncidence of new MRSA regardless of statusDenominatorsVRE denominators (patients that dont have VRE)MRSA denominators (patients that dont have MRSA)Total number of patients known to have MRSATotal number of patients known to have VRERatio of incident cases to prevalent cases of MRSARatio of incident cases to prevalent cases of VREfor Chi-sq VREfor Chi-sq MRSA4 week intervals for VRE4 week denominators for VREdenom for Chi-sqincidence of VRE by 4 week interval4 weeks for MRSA4 week denominators for MRSAdenom for Chi-sq MRSAincidence of MRSA by 4 week interval

104/23/0289277.5%8.7%8.5%776.6%7.4%6.6%1061049511238.9%81.8%9588273973706.8%193693505.1%

204/30/02810227.5%10.1%9.3%554.7%5.3%4.7%107999413827.8%55.6%8989223923705.6%263523267.4%

305/07/0256114.6%6.0%5.5%332.8%3.3%2.8%1091009118914.3%40.0%9488114184072.6%133933803.3%

405/14/0222141.9%2.1%1.9%443.8%4.5%3.8%1059489161120.0%15.4%9285144564423.1%184314134.2%

505/21/02810147.3%10.2%9.1%10109.1%11.0%9.1%1109891191234.5%45.5%8881143823683.7%133613483.6%

605/28/0233142.9%3.3%2.9%665.8%7.3%5.8%1049082221421.4%17.6%8776144234093.3%93963872.3%

706/04/023492.7%4.0%3.6%332.7%3.6%2.7%1121018428119.7%26.7%978194454362.0%84304221.9%

806/11/025564.5%4.9%4.5%776.3%7.4%6.3%1121039517929.2%35.7%988864334271.4%164033874.0%

906/18/023592.6%4.9%4.3%332.6%3.2%2.6%11510394211212.5%29.4%989194794701.9%124484362.7%

1006/25/0212150.8%1.8%1.7%554.2%5.0%4.2%11911010118921.7%18.2%10896154684533.2%134494362.9%

1107/02/022361.8%2.9%2.7%332.7%3.1%2.7%1111029811921.4%25.0%9995

1207/09/02110.9%1.0%0.9%221.8%2.0%1.8%11210310012914.3%10.0%10298

1307/16/02241.5%3.3%3.1%443.1%3.5%3.1%13012211515821.1%33.3%118111

1407/23/02352.3%4.1%3.8%553.8%4.3%3.8%132122116161023.8%33.3%117111

1507/30/02655.1%4.6%4.2%453.4%5.0%4.2%11810910018921.7%35.7%10495

1608/06/02000.0%0.0%0.0%040.0%4.0%3.4%118103100181518.2%0.0%10396

1708/13/02333.0%3.4%3.0%242.0%4.8%4.0%1008784161320.0%18.8%8480

1808/20/02121.0%2.1%1.9%665.7%6.4%5.7%105969411935.3%18.2%94889492

1908/27/02231.8%3.0%2.7%110.9%1.1%0.9%1101009416105.9%23.1%9793

2009/03/02564.7%6.1%5.6%120.9%2.2%1.9%107998918810.0%42.9%9387

2109/10/02362.4%5.0%4.8%332.4%2.8%2.4%12511910619613.6%50.0%113103

2209/17/02241.8%3.8%3.6%221.8%2.1%1.8%1121059418710.0%36.4%10192

2309/24/02332.7%2.9%2.7%000.0%0.0%0.0%11310210011110.0%21.4%99100

2410/01/02110.9%1.0%0.9%342.8%4.2%3.8%106979610928.6%10.0%9692

2510/08/02221.7%1.7%1.7%221.7%1.9%1.7%11811510513313.3%40.0%113103

2610/15/02120.9%1.9%1.8%110.9%1.0%0.9%1131071031069.1%25.0%105102

2710/22/02110.8%0.9%0.8%443.3%3.6%3.3%12110811291130.8%8.3%107108

2810/29/02443.3%3.5%3.3%010.0%0.9%0.8%1221151101277.7%36.4%111109

2911/05/02332.5%2.7%2.5%332.5%2.9%2.5%11811110315716.7%30.0%108100

3011/12/02120.8%1.8%1.6%574.1%6.7%5.7%123111104191226.9%14.3%10997

3111/19/02110.9%1.0%0.9%443.7%4.6%3.7%1079687201116.7%8.3%9583

3211/26/02000.0%0.0%0.0%221.6%1.8%1.6%125115109161011.1%0.0%115107

3312/03/02020.0%1.7%1.6%332.4%2.7%2.4%12311711112620.0%25.0%115108

3412/10/02120.8%1.7%1.6%332.4%2.7%2.4%12711911215816.7%20.0%117109

3512/17/02120.8%1.6%1.5%443.1%3.5%3.1%13112511516620.0%25.0%123111

3612/31/02332.4%2.5%2.4%221.6%1.8%1.6%12311811013513.3%37.5%115108

3701/07/03342.4%3.4%3.2%332.4%2.9%2.4%12511810513718.8%36.4%114102

3801/14/03443.4%3.7%3.4%443.4%3.8%3.4%11710810413923.5%30.8%104100

3901/21/03342.2%3.2%3.0%231.5%2.4%2.2%134124123111021.4%28.6%120120

4001/28/03332.3%2.5%2.3%332.3%2.6%2.3%128118117111021.4%23.1%115114

4102/04/03463.2%5.2%4.8%241.6%3.6%3.2%126115110161120.0%35.3%109106

4202/11/030.0%0.0%0.0%0.0%0

4302/18/030.0%0.0%

4402/25/030.0%Ratio for MRSA = 47/(36+47)56.6%

4503/04/03ratio for VRE =76.8%

MRSA Screening Program in an SICU, Hospital of Saint RaphaelAll patients are screened on admission to SICUAnterior nares and any open wd are culturedAny patient remaining in SICU for > 7 days are cultured weeklyAll patients colonized/infected with MRSA are placed in Contact Precautions

SICU-Acquired MRSA InfectionsPer 100 Patient-Days, Oct 2002 - Sep 2003Infect Control Hosp Epidemiol 2004; 25:395Screening Patientson Admission Period 1 Period 2

Infect Dis Hosp Epidemiol 2004; 25:395

Impact of Routine ICU Surveillance Cultures and Resultant Barrier Precautions on Hospital-Wide MRSA BacteremiaClin Infect Dis 2006; 43:971

MRSA HAI Rates 4W Unit, Pittsburgh VA, Oct 1999 - 2004VA MRSA bundle was associated with a > 80% reduction of MRSA infection rate on their surgical step down unit

MRSA HAI Rates MICU University of Pittsburgh 2000-2005Muto et al. SHEA Los Angeles, 2005

CommonalitiesDifferences

There are a growing number of studies suggesting that US healthcare facilities can successfully prevent MRSA infections

Although the effectiveness of active surveillance to reduce MRSA transmission has not been established in randomized trials, there is mounting evidence that active surveillance combined with other measures such as contact isolation, hand washing, and education can reduce MRSA transmission

SHEA Guidelines for Preventing Nosocomial Transmission of MRSAInfect Control Hosp Epidemiol 2003; 24:362

Implement a program of active surveillance cultures and contact isolation to control significant antibiotic-resistant pathogens-most of the reservoir for spread of multi-resistant pathogens come from asymptomatic, colonized patients who are unrecognizedSurveillance cultures are indicated at the time of admission for patients at high risk of MRSA

SHEA Guidelines #2Barrier precautions for patients with known or suspected to be colonized or infected with antibiotic-resistant pathogens such as MRSAAntibiotic stewardship-avoid inappropriate or excessive antibiotic prophylaxis and therapyUse hospital computers to identify patients readmitted with previous infection or colonization with multi-drug resistant pathogens

Management of MDRO in Healthcare Settings, 2006HICPAC GuidelinesOctober 2006

Control InterventionsAdministrative-communications e.g. computer alerts-adequate sinks and alcohol dispensers-staffing levels -adherence to IC practicesEducationJudicious use of antimicrobial agents

Control Interventions #2MDRO surveillance-antibiograms unit specific is possible-MDRO infection rate-molecular typing-active surveillance (consider if incidence ofMDRO is not decreasing despite routinemeasures)-contact precautions (all patients either colonized or infected

Control Interventions #3When active surveillance is indicated as part of an intensive MDRO program implement contact precautions until culture is reported negative for target MDROEnvironmental measuresDecolonization-not sufficiently effective to warrant routine useDuration of Contact Precautions-unresolved issue

Strategies to Win The 5 Million Lives CampaignInstitute for Healthcare ImprovementThis document is in the public domain and may be used and reprinted without permission provided appropriate reference is made to the Institute for Healthcare Improvement.

5 Million Lives CampaignThe PlatformReduce Surgical Complications Adopt SCIPPrevent Harm from High Alert MedicationsPrevent MRSA InfectionsReduce Readmissions from Congestive Heart FailurePrevent Pressure UlcersGet Boards on Board

Prevent MRSA InfectionThe Goal: Reduce methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection by December 2008Focus on getting to zero

Five Key InterventionsHand hygieneDecontamination of the environment and equipmentActive surveillance cultures (ASCs)Contact precautions for infected and colonized patientsCompliance with Central Venous Catheter and Ventilator Bundles

Adverse Effects of Contact IsolationLancet 1999; 354:1177Health-care workers who treated patients in contact isolation entered their rooms less frequently and had less direct contact with them than those caring for controlsHandwashing compliance was higher among health-care workers who cared for patients in contact isolation than among those who cared for controlsPhysicians were less likely than other health-care workers to wash their hands

Safety of Patients Isolated for Infection ControlJAMA 2003; 290:1899Isolated patients were less likely than control patients to have their vital signs accurately recorded, to have daily physician progress notes documented, and to achieve selected disease specific standards of careIsolated patients were more likely to experience a preventable adverse event and to express dissatisfaction with their careHospital mortality rates were similar in both groups

Active Surveillance CulturesPros

ConsIceberg effectClinical trial show benefitCost, morbidity & mortalityOther approaches have failed

Trials are quasi-experimentalCost data limitedAttributable mortality difficult to judgeAssumes one size fits allUnintended consequences

MRSA Risk AssessmentConduct a risk assessment of MRSA incidence, prevalence, acquisition, and transmissionData useful in performing risk assessmentProportion of S. aureus isolates resistant to methicillinThe number and/or incidence of new cases of MRSA over timeThe number of cases and/or incidence of one or more specific types of MRSA infection (e.g. bacteremia) over timePoint prevalence survey(s) of MRSA colonization/infectionColonization pressure (ratio of MRSA-carrier days to total patient days) ICHE 2000; 21:718

Elements of an Effective ASC ProtocolSound infection control departmentInstitutional supportEngage medical staffMicrobiology protocolInvolvement of multiple departments throughout facilityPatient and staff education

Steps to Consider Before Implementing Active SurveillanceClin Infect Dis 2007;44:1101Preparing the laboratoryMonitoring and optimizing instituting contact isolationMonitoring unintended consequences contact isolationMeasuring outcomes to evaluate effectiveness of interventions

Patient Study(IPM, IPS, ICU, ATU, Hemodialysis)September 2006Overall S. aureus colonization = 32% (69/217)of which 17 / 217 +MRSA = 7.8%

Chart1

0.0783410138

0.1168224299

Colonization Rate

MRSA Colonization Ratesby Traditional Culture & Rapid PCR Methods

7.8%(17/217)

11.7%(25/214)

EmplGraphs(3)

Rapid PCR Method

21-40 Years4.8%6/126

41-60 Years9.0%16/178

22/304

21-40 Years4.8%6/126

41-60 Years9.0%15/16615166

>60 Years8.3%1/12112

22/30416178

Rapid PCR Method

Female4.7%

Male13.0%

Females Tested69.7%

Males Tested30.3%

&C&"Arial,Bold"&12MRSA Point-Prevalence Study&"Arial,Regular"&10&"Arial,Bold Italic"&11Employee Study&"Arial,Regular"&10&"Arial,Italic"September/October 2006

EmplGraphs(3)

0

0

Rapid PCR Method

By Age

9.0%(16/178)

4.8%(6/126)

8.3%(1/12)

11.9%(8/67)

8.3%(1/12)

6.9%(2/29)

14.0%(6/43)

9.1%(4/44)

6.7%(2/30)

20.0%(1/5)

EmplGraphs(2)

0

0

Males Tested, 30.3%(92/304)

Females Tested, 69.7%(212/304)

EmplTitleGender

Rapid PCR Method

21-40 Years4.8%6/126

41-60 Years9.0%15/166

>618.3%1/12

22/304

21-40 Years4.8%6/126

41-60 Years9.0%15/16615166

>60 Years8.3%1/12112

22/30416178

Rapid PCR Method

Female4.7%

Male13.0%

Females Tested69.7%

Males Tested30.3%

13.0% of Males tested were MRSA+(12/92)

4.7% of Females tested were MRSA+(10/212)

&C&"Arial,Bold"&12MRSA Point-Prevalence Study&"Arial,Regular"&10&"Arial,Bold Italic"&11Employee Study&"Arial,Regular"&10&"Arial,Italic"September/October 2006

&L&"Arial,Italic"&8C:IC:MRSA/mrsa2006studydatabase/srf

EmplTitleGender

0

0

0

Rapid PCR Method

By Age

9.0%(15/166)

4.8%(6/126)

8.3%(1/12)

11.9%(8/67)

8.3%(1/12)

6.9%(2/29)

14.0%(6/43)

9.1%(4/44)

6.7%(2/30)

20.0%(1/5)

EmplDiscGender

00

Female

Male

By Gender

4.7%(10/212)

6.5%(6/93)

13.0%(12/92)

EmplDiscOvrall

0

0

Males Tested, 30.3%(92/304)

Females Tested, 69.7%(212/304)

Employee

Overall Raten=304YesNoUnresolved

MRSA+ by PCR(22/304)7.2%7.1%91.3%1.6%309100.0%

Non-clinical Personnel1.3%

Support Personnel2.7%

Nursing7.7%

Licensed Provider17.3%

Overall RateMaleFemaleOverall #Male #Female #

Non-clinical Personnel1.3%6.7%0.0%1/761/150/61

Support Personnel2.7%5.3%1.8%2/751/191/56

Nursing7.7%10.0%7.4%6/781/105/68

Licensed Provider17.3%19.6%12.5%13/7510/513/24

MaleFemaleOverall Rate

Non-clinical Personnel6.7%0.0%1.3%

Support Personnel5.3%1.8%2.7%

Nursing10.0%7.4%7.7%

Licensed Provider19.6%12.5%17.3%

OverallMaleFemaleMD18.6%20.0%14.3%

NP25.0%100.0%14.3%

MD18.6%20.0%14.3%

PA0.0%0.0%0.0%

MaleFemale

MD20.0%14.3%

NP100.0%14.3%

PA0.0%0.0%

13.0% of Males tested were +(12/92)

4.7% of Females tested were +(10/212)

&C&"Arial,Bold"&14MRSA Point-Prevalence Study&12Employee Study &"Arial,Regular"&10September/October 2006

&L&"Arial,Italic"&8

Employee

0

0

0

0

0

0

Overall MRSA Colonization Ratesby PCR Method

7.2%

7.1%(22/309)

1.3%(1/76)

2.7%(2/75)

7.7%(6/78)

17.3%(13/75)

Patients

0

0

0

Nursing = RN, LPN, CNA, patient care techsLicensed Provider = physician, NP, PASupport Personnel = PT, OT, ST, RT, pharmacist, care management, dieticianNon-clinical Personnel = business office, finance marketing staff, catering

Male

Female

Overall Rate

MRSA Colonization Rates By Discipline / Gender(PCR Method)

19.6%10/51

10.0%1/10

5.3%1/19

6.7%1/15

12.5%3/24

7.4%5/68

1.8%1/56

0.0%0/61

17.3%13/75

7.7%6/78

2.7%2/75

1.3%1/76

0

0

0

0

0

0

0

0

0

0

0

0


Male

Female

MRSA Colonization RatesLicensed Provider by Gender

0.0%(0/5)

20.0%(9/45)

100.0%(1/1)

0.0%(0/3)

14.3%(1/7)

14.3%(2/14)

0

0

0

0

0

0

Overall

Overall MRSA Colonization RatesBy Licensed Provider

25.0%(2/8)

18.6%(11/59)

0.0%(0/8)

MethodsDept3D


MRSA+ by PCR(22/304)7.2%7.1%91.3%1.6%309100.0%



Nursing7.7%


Overall RateMaleFemaleOverall #Male #Female #

Non-clinical Personnel1.3%6.7%0.0%1/761/150/61

Support Personnel2.7%5.3%1.8%2/751/191/56

Nursing7.7%10.0%7.4%6/781/105/68

Licensed Provider17.3%19.6%12.5%13/7510/513/24

MaleFemaleOverall Rate

Non-clinical Personnel6.7%0.0%1.3%

Support Personnel5.3%1.8%2.7%

Nursing10.0%7.4%7.7%

Licensed Provider19.6%12.5%17.3%


&L&"Arial,Italic"&8

MethodsDept3D

0

0

0

0

0

0


7.2%

7.1%(22/309)

1.3%(1/76)

2.7%(2/75)

7.7%(6/78)

17.3%(13/75)

MethodsDeptsBar

000

000

000

000


Male

Female

Overall Rate

MRSA Colonization Rates By Discipline / Gender(PCR Method)

19.6%10/51

10.0%1/10

5.3%1/19

6.7%1/15

12.5%3/24

7.4%5/68

1.8%1/56

0.0%0/61

17.3%13/75

7.7%6/78

2.7%2/75

1.3%1/76

0

0

0

0

0

0

0

0

0

0

0

0

Overall Rate

Male

Female

MRSA Colonization Rates by Discipline / Gender(PCR Method)

17.3%13/75

7.7%6/78

1.3%1/76

2.7%2/75

19.6%10/51

10.0%1/10

5.3%1/19

6.7%1/15

0.0%0/61

1.8%1/56

7.4%5/68

12.5%3/24

MethodsDeptsPie


MRSA+ by PCR(22/304)7.2%7.1%91.3%1.6%309100.0%



Nursing7.7%




&L&"Arial,Italic"&8C:MRSA/mrsa2006studydatabase/srf

MethodsDeptsPie

0

0

0

0

0

0


7.2%

7.1%(22/309)

1.3%(1/76)

2.7%(2/75)

7.7%(6/78)

17.3%(13/75)

AgeBarGr

EMPLOYEE IDENTIFIERDISCIPLINECOLLECTIONDATEPCR TESTRESULTS Pos / NegAGEGENDER

M / FLegend:

ENCRN9/20/06Neg50FEN = nursing personnel (RN, LPN, CNA, MA)

ESRN (ICP)9/20/06Neg38FEP = physician, NP, PA

ESMT (ICP)9/20/06Neg56FES = support personnel, PT, OT, ST, RT, Pharmacist

ESRN (ICP)9/20/06Neg45F(study does not include EVS)

ESRN (ICP)9/20/06Neg49FENC = Non-clinical personnel (volunteer, business office,

ENCMT9/20/06Neg50Ffinance, marketing staff)

ENCMT9/20/06Neg43F

ENCMT9/20/06Neg33F

ENCLAB9/20/06Neg23F

ENCMT9/20/06Pos31M

ESPHLEB9/20/06Neg23F

ENCRN9/20/06Neg42F

ESUNIT CLERK9/20/06Neg27F


ENRN9/20/06Neg27F

ENRN9/20/06Neg36F

EPMD9/20/06Neg42M

ENLPN9/20/06Neg36F

ENRN9/20/06Neg23F

ENRN9/20/06Neg32F

EPMD9/20/06Neg50M

EPMD9/20/06Neg32F

ESRN9/20/06Neg58F

ENRN9/20/06Pos46F

ESPHARMACY9/20/06Neg40F

ESRN (CM)9/20/06Neg33F

ENRN9/20/06Neg44F

ENRN9/20/06Neg31F

ENRN9/20/06Neg40F

ENRN9/20/06Neg30F

ENRN9/20/06Neg26M

EPMD9/20/06Neg58M


ESPHARMACY9/20/06Neg31M

ENRN9/20/06Pos59F

ENCANALYST9/26/06Neg48F

EPMD9/26/06Pos37M

ENLPN9/26/06Neg54F

ESOT9/26/06Neg42F

ENCNA9/26/06Neg40F

ESOT9/26/06Neg29F


ENRN9/26/06Neg52F

EPMD9/26/06Neg53M

EPMD9/26/06Pos49M

EPMD9/26/06Pos40F

ESRT9/26/06Neg38M

ENRN9/26/06Neg40F

ENRN9/26/06Neg55F

ENRN9/26/06Neg31F

ENRN9/26/06Neg44F

ENRN9/26/06Neg32F


ENRN9/26/06Neg29F

ESPHARMACIST9/26/06Neg26M

ENRN9/26/06Neg51F

ENLPN9/26/06Neg56F

ENRN9/26/06Pos58F

ENRN9/26/06Neg54F

ENRN9/26/06Neg27F

ENPC TECH9/26/06Neg22F




EPPA9/26/06Neg55M

ENCANALYST9/26/06Unresolved45F

ENCCLERICAL9/26/06Neg25M


ENCTECH ASST9/27/06Neg57F

ENCBUSINESS OFFICE9/27/06Neg35F





ENCBUSINESS OFFICE9/27/06Neg50M

ENRN9/27/06Neg48F

ENRN9/27/06Neg35M

ESRESP THERP9/27/06Neg44M

ESRESP THERP9/27/06Neg53M

ENCRN9/27/06Neg57F

ENCRNR9/27/06Neg53F

ENCRN9/27/06Neg65F

ENCCLERICAL9/27/06Neg48F

ENCADMIN9/27/06Neg49F



ENCRN9/27/06Neg46F

ENRN9/27/06Pos51F

ENRN9/27/06Neg43F

ENCADMIN9/27/06Neg40M


ESIS9/27/06Neg42F

ESFACILITIES9/27/06Neg44M



ENCMATERIALS9/27/06Neg62M


ENCMATERIALS9/27/06Neg48F


ENCLAB9/27/06Neg38F

ENCRN9/29/06Neg40F

ENCFINANCE9/29/06Neg66F

ENCFINANCE9/29/06Neg43M

ENCRN9/29/06Neg45F





ENCMARKETING9/29/06Neg48F


ENCMARKETING9/29/06Neg41M





ENMA9/29/06Neg56F

ENLPN9/29/06Neg57F

EPMD9/29/06Neg55M

EPMD9/29/06Neg44M

ENLPN9/29/06Neg22F

EPMD9/29/06Neg32M

ENLPN9/29/06Pos56F

ENLPN9/29/06Neg33F

ESPT9/29/06Neg35M

ENRN9/29/06Neg49F

ENRN9/29/06Neg48F

ENRN9/29/06Neg48F

ESSUPPORT9/29/06Neg30F


ENRN9/29/06Neg43F

EPMD9/29/06Neg38F

ENRN9/29/06Neg46F

EPMD9/29/06Neg44F

EPMD9/29/06Neg44M

ENLPN9/29/06Neg66F

ESUNIT CLERK9/29/06Neg53M

ENRN9/29/06Neg31F

EPMD9/29/06Neg56F

ENRN9/29/06Neg45F

ESPC TECH9/29/06Neg37F

ENRN9/29/06Neg43M

ENCSUPPORT9/29/06Neg48M



EPMD9/29/06Neg55M

ENCCATERING9/29/06Neg41F

EPMD9/29/06Neg32M

EPMD9/29/06Neg45M

EPMD9/29/06Neg43M

EPMD9/29/06Neg49M

EPMD9/29/06Neg52M

EPMD9/29/06Unresloved57M

ESADMIN9/29/06Neg53F

EPNP9/29/06Neg50F

EPNP9/29/06Neg50F

ENRN9/29/06Neg27F

EPMD9/29/06Neg48F

ENRN9/29/06Neg56F

ENRN9/29/06Neg53F

ESOT9/29/06Neg39F

EPNP9/29/06Pos33F

ESRT9/29/06Neg47M

EPMD9/29/06Neg39M

ENCNA9/29/06Neg59F

ENCNA9/29/06Neg22M

ESOT9/29/06Pos31F

ENCNA9/29/06Neg25F

ENCNA9/29/06Neg30F

ENCNA9/29/06Neg21F

EPMD9/29/06Neg54M

ESOT9/29/06Neg30M

ESPHARMACIST9/29/06Neg33M

ESPHARMACIST9/29/06Neg28F

ENMA/CNA9/29/06Neg46F

ESRT9/29/06Neg48F

EPMD (RESIDENT)10/2/06Neg27M

ESPT10/2/06Neg34F

ESOT10/2/06Neg35F

EPPA10/2/06Neg33F

ESPT10/2/06Neg43F

ESPT10/2/06Neg46F

ESPT10/2/06Neg46F

ESPT10/2/06Neg30M

ESSPEECH THERP10/2/06Neg43F

ESSPEECH THERP10/2/06Neg27F

ESOT10/2/06Neg48F

ESPT10/2/06Neg28F

ESPT10/2/06Neg55F

ESOT10/2/06Neg33F

EPMD10/2/06Neg43M

ENLPN10/2/06Pos64F

EPMD10/2/06Neg44F

ENRN10/2/06Neg30F

ENRN10/2/06Neg27F

ENRN10/2/06Neg23F

ENCNA10/2/06Neg56F


ESPT10/2/06Neg28F

EPMD10/2/06Neg35M


ENRN10/2/06Neg32F

ESRN10/2/06Neg53F

ENCNA10/2/06Neg67F

ESSOCIAL SERV10/2/06Neg68M

ESRN10/2/06Neg50F

ENRN10/2/06Neg57F

ENCNA10/2/06Neg33F

EPMD10/2/06Neg34F

ESCM10/2/06Neg52F

EPMD10/2/06Pos50M

EPPA10/2/06Neg35F

EPPA10/2/06Neg34M

ENRN10/2/06Neg29F

ESRN10/2/06Neg54F

ENRN10/2/06Neg29F

ENRN10/2/06Neg30F

ENCNA10/2/06Neg32M

ENRN10/2/06Neg45F

ESDIETARY10/2/06Neg24F

ESRADIOLOGY10/2/06Neg59F

ESRADIOLOGY10/2/06Pos50M

ENRN10/2/06Neg47M


ENRN10/2/06Unresloved43F

ENRN10/2/06Neg26F

ENRN10/2/06Neg43F

ENRN10/2/06Neg31F

ENRN10/2/06Neg39F

ENRN10/2/06Neg55F

EPMD10/2/06Neg51M

EPMD10/2/06Neg41F

ENRN10/2/06Neg55M

ENRN10/2/06Neg38F

EPMD10/3/06Neg42F

EPMD10/3/06Neg47M

EPMD10/3/06Neg42M

EPMD10/3/06Neg53M

EPPA10/3/06Neg42F

EPMD10/3/06Pos58M

EPMD10/3/06Pos52M

EPNP10/3/06Neg49F

EPMD10/3/06Pos34M

EPMD10/3/06Neg50M

EPMD10/3/06Neg52M

EPMD10/3/06Neg40M

EPMD10/3/06Pos59M

EPMD10/3/06Pos49M

EPNP10/3/06Pos42M

EPNP10/3/06Neg47F

EPMD10/3/06Neg44M

EPPA10/3/06Neg54M


EPPA10/3/06Neg50M

EPMD10/3/06Neg65M

EPMD10/3/06Neg56M

EPMD10/3/06Neg54F

ESCLERICAL10/3/06Neg48F

EPMD10/3/06Neg38M

ESPC TECH10/3/06Neg36M

ENCRN10/3/06Neg41F

EPPA10/3/06Neg33M

ESPHARMACY10/3/06Unresloved52F

EPMD10/3/06Neg41M

EPNP10/3/06Neg42F

ESPHLEB10/3/06Unresloved25F

ESPHLEB10/3/06Neg33M

ESPHLEB10/3/06Neg25F

ENCIS10/6/06Neg38M

EPMD10/6/06Pos57M


EPMD10/6/06Neg35F

ESPHARMACIST10/6/06Neg36F

ESDIETICIAN10/6/06Neg29F

ESCM10/6/06Neg53M

ESCM10/6/06Neg50F

ESCARE SPEC10/6/06Neg35F

EPMD10/6/06Neg62M


EPMD10/6/06Neg28M

EPMD10/6/06Neg57F


ESRT10/6/06Neg33F

EPMD10/6/06Pos42F

ESCM10/6/06Neg55F






















EPMD10/6/06Neg61M

EPNP10/6/06Neg52F

EPMD10/6/06Neg45M

EPMD10/10/06Neg32M


&C&"Arial,Bold"&14MRSA Point-Prevalence Study &"Arial,Regular"&10&"Arial,Bold Italic"&12Employees&"Arial,Regular"&10September 2006

AgeGenderBar110606

PATIENT NAMEAGEGENDERRM #PATIENT IDENTIFIER*DATE OFSPECIMENTEST RESULTSDIABETES(Diagnosis of Diabetes or oral hypoglycemia or insulin RX)PRIOR HOSP(inpt stay within last year)LONG-TERM CARE STAY(Any resident facility within last year)PRIOR ABX(prior ABX, Rx or empiric within last 6 wks; excludes surgical prophylaxis)DIALYSIS(Hemodialysis)

CULTUREPCR*Legend:

(Years)(M / F)(MRSA / MSSA)(Pos / Neg)(Y / N)(Y / N)(Y / N)(Y / N)(Y / N)M = Medical

Oldmouse, Roger63M2201A19/6/06NegNegYYNNNS = Surgical

Fox, James69M2202A29/6/06NegNegNNNNND = Dialysis

Laroche, L W74M2204A39/6/06NegNegYYNYNI = ICU

Spottedwolf, George28M2205A49/6/06NegNegYNNYNA = ATU

Worthington, James71M2208A69/6/06NegNegNNNNN

Mischel, Henry50M2209A79/6/06NegNegNYNYN

Lawellin, Leslie81M2210A89/6/06NegNegYNNNN

Overhuls, Wayne72M2210A99/6/06NegNegNNNNN

Fohy Canfield, Vicki44F2212A109/6/06MSSANegYYNNN

Pierce, Karen63F2214A119/6/06NegNegYYNYN

Shirer, Karen54F2215A129/6/06NegNegNNYYN

Pasley, Joseph95M2216A139/6/06MSSANegNNNNN

Laird, Lois70F2217A149/6/06MSSANegYNNNN

Bennett, Cheryl57F2218A159/6/06NegNegNNNNN

Jones, Vicki61F2219A169/6/06NegNegNNNNN

Johnson, Yvonne70F2221A179/6/06NegNegNYNNN

Boland, Floyd74M2222A189/6/06NegNegNNNNN

Chapman, Kathryn95F2223A199/6/06NegNegNNNNN

Burgett, Richard77M2224A209/6/06MSSANegYNNNN

Casey, Marlene65F22225A219/6/06NegNegYYNNN

Schuster, Meghan19F2226A229/6/06NegNegNNNNN

Stevens, Melzer81M2228A239/6/06NegNegYNYNN

Oberg, Cindy41F2229A249/6/06MSSANegNYNNN

Walter, Norma67M2230A259/6/06NegNegNNNNN

Simondi, Domenic83M2231A269/6/06MRSAPosNNNYN

Campbell, Barbara74F2233A279/6/06NegNegNNNNN

Sullens, John60M2234A289/6/06NegNegYNNNN

Condie, Donald79M2235A299/6/06MSSANegYYNNN

Wilkinson, Patricia76F2236A309/6/06NegNegNNNNN

Hapa, Frank29M2237A319/6/06MRSAPosYNNYN

Magnuson, August82M2203A329/7/06NegNegNNNNN

Littlecoyote, Perry72M2232A339/7/06NegNegYYNNY

Law, Teresa45F2222A349/8/06NegNegNYNNN

Campbell, Junia95F301M359/11/06NegNegYYYYN

Wing, Helen47F302M369/11/06MRSAPosNNNYN

Felt, Margaret84F304M379/11/06NegNegNNNNN

Dick, Douglas44M305M389/11/06NegNegNNNYN

Baertsch, Donald82M317M399/11/06MSSANegNYNNN

Leidholt, Philip81M318M409/11/06NegNegNNNNN

Brady, Leroy56M319M419/11/06NegPosYYNYY

Cooke, Harvey40M320M429/11/06MSSANegNYNNN

Lesher, Albert75M322M439/11/06NegNegNYNYN

Stricker, Joyce86F324M449/11/06NegNegNNNYN

Reavis, Jess70M326M459/11/06MRSAPosYYNNY

Farley, Joni37F327M469/11/06MSSAPosYYNYN

Fifer, William74M328M479/11/06NegNegNYNYN

Beehler, Alfred70M350M489/11/06NegUnresolvedNYYYN

Brainerd, Jessica23F354M499/11/06NegNegYYNNN

Beley, Beulah94F355M509/11/06NegNegNYYYN

Walker, Lorrin60M356M519/11/06NegNegYYNYN

Riddle, Vina80F357M529/11/06NegNegNNNYN

Hardt, Lydia94F359M539/11/06MRSAPosNNNNN

Sorensen, John54M360M549/11/06NegNegYYNYN

Tyler, Randy58M361M559/11/06NegPosYYNNY

Cline, William46M362M569/11/06NegNegNYNYN

Fewins, Bonnie57F363M579/11/06NegNegNYNYY

Nottingham, Donald57M373M589/11/06NegNegNNNYN

Mainwaring, Duane67M374M599/11/06MRSAPosYYNYN

Evans, Mary58F365M609/11/06NegNegNYNYN

Henzie, Niki29F366M619/11/06NegNegNYNNN

Eggert, Bradley50M367M629/11/06NegNegYYNYN

Miller, Larry47M321M639/12/06MSSAPosYYNNN

Stroup, Charles56M325M649/12/06MSSANegYNNNN

Yorgason, Merrill77M303M659/12/06MSSANegYYNNY

Hansen, Larry41M370M679/12/06NegNegNNNNN

McKinlay, Joan86F371M689/12/06NegNegNNNNN

Kaufmann, Rosalyn47F364M699/12/06NegNegNYNYN

Richardson, Dorothy79F252S739/12/06NegNegYYNYN

Keller, Lia37F254S749/12/06NegNegNNNNN

Stafanik, Maxine73F255S759/12/06NegNegNYNNN

Friez, Doris84F256S769/12/06NegNegNYYNN

Riegel, Delores72F257S779/12/06NegNegNYNNN

Bernethy, Matthew45M259S789/12/06NegNegNNNYN

Fisher, Marvin63M260S799/12/06NegNegNNNYN

Harman, Paul75M261S809/12/06NegNegNNNNN

Hopkins, Cindy37F262S819/12/06MSSANegNNNNN

Redstone, Jeremy26M263S829/12/06NegNegNNNNN

Christensen, Scott48M264S849/12/06NegNegNYNYN

Littleboy, Patrick57M266S859/12/06MRSANegYNNNN

Rininger, Joann57F267S869/12/06NegNegNNNNN

Dally, Rodney68M268S879/12/06MSSANegNNNNN

Spiers, Alan65M270S889/12/06NegNegNNNYN

Saxton, Edna89F271S899/12/06NegNegNYNYN

Kiley, Marilyn71F203S909/12/06NegNegNNNYN

Frerck, Shirley79F204S919/12/06MRSAPosNNNYN

Magee, Fannie84F205S929/12/06MSSANegNYYYY

Pennell, Ronald64M206S939/12/06NegNegNNNNN

Collins, Marvin71M207S949/12/06MSSANegYYNNN

Minergoodrie, Kinsey15F208S959/12/06NegNegNNNYY

Stoot, Brian45M210S969/12/06MSSANegNYNNN

Smotherman, Homer43M214S979/12/06NegNegNNNYY

Odell, Jay38M215S999/12/06NegNo specimenNNNYY

Taylor, Rober81M216S1009/12/06NegNegNYNNN

Carpentermillis, Leanne51F217S1019/12/06NegNegNNNYY

Sundquist, Megan24F218S1029/12/06NegNegNNNYY

Maerz, Jeff43M219S1039/12/06MSSANegNNNNN

Lundy, Richard85M211S1049/12/06NegNegNNNNN

Dodd, Beverly46F1D1059/13/06NegNegNYNNY

Baysinger, Diana39F2D1069/13/06MSSAPosNNNNY

Defrance, Dennis63M3D1079/13/06MRSAPosYNNNY

Askin, Kerry56F4D1089/13/06NegNegYNYNY

Baker, Melvin81M5D1099/13/06NegNegNYNYY

Martinez, Robert68M7D1109/13/06NegPosYYNNY

RoundFace, Carrie51F8D1119/13/06MSSANegYYNYY

Banderob, Martha53F9D1129/13/06NegNegNNNNY

Turnsplenty, Lenora64F10D1139/13/06MSSANegYNNNY

Mascarena, Leo67M12D1149/13/06NegNegNNNNY

Lunder, Donald79M13D1159/13/06NegNegNYNYY

Collins, Janice63F2101I1169/13/06NegNegNNNNN

Johnston, Phillip48M2102I1179/13/06MSSANegNNNNN

Davis, Terry60M2103I1189/13/06MSSANegNNNNN

Hemphill, Clifton47M2104I1199/13/06NegNegNYNNN

Smith, Robin23F2114I1209/13/06MSSANegNNNYN

Weir, Allen6M2116I1219/13/06NegNegNYNYN

Cline, Daniel53M2117I1229/13/06MRSAPosYNNNN

Cohn, Jane81F2120I1239/13/06NegNegNYNNN

Horton, Howard70M2121I1249/13/06NegNo specimenNNNNN

Sloate, Robert68M2122I1259/13/06NegNegYYYNN

Welk, Kevin44M2124I1269/13/06NegNegNNNNN

Gauna, Jimmy21M208S1279/13/06NegNegNNNYN

Christensen, Calvin50M212S1289/13/06NegNegNNNNN

Redstar, Randi49M1D1299/13/06MSSANegYYYNY

Weis, Jefferey48M2D1309/13/06NegNegYNYNY

Taylor, Morton74M3D1319/13/06MRSAPosYYYNY

Tanner, Dave67M4D1329/13/06NegNegNYNYY

Jarvi, Edward64M5D1339/13/06MSSANegNNYNY

Ericksen, Maurine76F6D1349/13/06MSSANegYYNNY

Coombs, Margaret85F7D1359/13/06MSSANegNNNNY

Hiwalker, Weaver63M9D1369/13/06MRSAPosYNNNY

Johnston, charla48F10D1379/13/06MSSANegNYYNY

Baum, Martha79F11D1389/13/06MSSANegYYYNY

Lizer, John64M12D1399/13/06NegNegYYYYY

Rose, Larry68M13D1409/13/06MSSANegNNNNY

Dewald, Linda58F2D1419/13/06NegNegYNNNY

Stein, Martin63M4D1429/13/06NegNegNYNYY

Smith, Howard75M5D1439/13/06MRSAPosNNNNY

Reed, Crawford36M7D1449/13/06MSSANegNNNNY

Hogan, Pearl86F8D1459/13/06NegNegNYNNY

Thompson, Annette80F9D1469/13/06NegNegNYNNY

Kline, Herman76M10D1479/13/06MSSANegYNNNY

Morgan, Nancy74F11D1489/13/06NegNegNNNNY

Campodonico, Edith71F12D1499/13/06NegNegNYNYY

Faw, Harold86M13D1509/13/06NegNegNYNNY

Lund, Charles57M2D1529/14/06NegNegYNNNY

Eckhardt, Robert79M3D1539/14/06MSSANegNNNNY

Page, Isabella68F4D1549/14/06MSSANegNNNNY

Falk, Larry64M5D1559/14/06MRSAPosNYNNY

Holzheimer, Dona74F6D1569/14/06MSSANegYYNNY

Wortham, Sheldon42M7D1579/14/06MSSANegNNNNY

Wipf, Paul73M8D1589/14/06NegNegYNNNY

Rodriguez, Audelia65F9D1599/14/06NegNegYYNNY

Engle, Clair71M10D1609/14/06NegNegYYNNY

Fowlie, James80M207S1619/14/06NegNegNYNYN

Gustafson, Vern81M210S1629/14/06NegNegNNNNN

Todd, Carmel83F219S1639/14/06NegNegNNNYN

Mahoney, Robert69M254S1649/14/06NegNegNYNNN

Ives, Frank84M256S1659/14/06MRSAPosYYNYN

Hatfield, Darren24M267S1669/14/06NegNegNNNNN

Baldwin, Charles41M2114I1679/14/06MSSANegNNNNN

Oswald, Randall49M2115I1689/14/06NegNegNNNNN

Seinner, Charles81M2119I1699/14/06NegNegNNNNN

Garza, James43M2123I1709/14/06NegNegNNNNN

Richardson, Theresa42F2110I1719/14/06MSSANegYNNNN

Roberts, Jack87M1D1729/14/06MSSANegYYNNY

Lee, Cheryl52F4D1739/14/06NegNegYYYNY

Cox, Samuel71M3D1749/14/06MRSAPosYNNNY

Whiteman, Leola60F6D1759/14/06NegNegYYNNY

Durose, Addeline85F7D1769/14/06NegNegNNNNY

Wagner, Wilbur77M8D1779/14/06NegPosYNNNY

Robins, Rayford78M9D1789/14/06MSSANegNYNNY

Watts, Ryan27M10D1799/14/06NegNegNYNYY

Fish, William84M11D1809/14/06MSSANegYYNNY

Bouwkamp, Marvin71M12D1819/14/06NegNegYYNNY

Littlemouth, Ernestine21F1D1829/14/06NegNegNYNYY

Stewart, Sarah80F2D1839/14/06NegNegYYNNY

Butler, Jennifer22F3D1849/14/06NegNegNYNYY

Feller, Cletya67F4D1859/14/06NegPosYNNNY

Medionebull, Doris46F5D1869/14/06NegNegYNNNY

Fowler, Jeffry35M6D1879/14/06NegNegYYNYY

Baker, Gail42M7D1889/14/06MRSAPosYNNNY

Frank, Raymond78M8D1899/14/06MSSANegNYNNY

Seright, Rosalie75F9D1909/14/06NegNegNNNNY

Rockabove, Adeline32F10D1919/14/06NegNegNYNNY

Gravgaard, Roger46M11D1929/14/06MSSANegYYNNY

Eames, Judy64F11D1939/15/06NegNegYYNYY

Krank, Mark47M201D1949/15/06NegNegNNNNN

McCracken, John61M401D1959/15/06NegNegNYNNN

Huffman, Edna68F414M1969/15/06NegNegNYYNN

Thomas, Erlyne65F404M1979/15/06NegNegNNNNN

Zumbrun, Cindy49F406M1989/15/06NegNegNNNNN

Miller, Norman78M405M1999/15/06MSSAPosNNNNY

McCarthy Schmidt, Erin35F407M2009/15/06MSSANegNNNNN

Ruby, Steven50M408M2019/15/06NegNegNNNYN

Green, Gary61M409M2029/15/06NegNegNYNYN

Odonnell, Betty71F410M2039/15/06NegNegNNNNN

Schick, Marie20F411M2049/15/06NegNegNYNNN

Nafts, Nadine55F2101I2059/15/06NegNegNNNNN

Allshouse, Larry49M2102I2069/15/06MSSANegNNNNN

Hunt, Karen65F2104I2079/15/06NegNegYNNNN

Payne, Michael52M2105I2089/15/06NegNegNYNYY

Blount, Sadie60F2109I2099/15/06NegNegYYNNN

Cebuhar, Robert54M2114I2109/15/06MSSANegNNNNN

Pierson, Lenore15F2120I2119/15/06NegNegNNNNN

Mikami, Keneth53M5D2129/15/06NegNegYYNNY

Kallinen, M E89F402M2139/19/06NegNegNYNNN

Arnold, William89M403M2149/19/06MSSANegNNNNN

Lambert, Joshua18M404M2159/19/06NegNegNNNNN

Vanover, C Anne83F406M2169/19/06NegNegYYNNN

Redboy, Shirley84M408M2179/19/06NegNegNNNNN

Spottedwolf, George64M302M2199/19/06NegNegYNNYN

Huffman, Edna68F414M2209/19/06NegNegNYYNN

Campbell, Shirley67F410M2219/19/06NegNegNYNYN

Roelman, Kristi38F304M2229/19/06MSSANegNYNNN

Carter, Sylvia74F304M2239/19/06NegNegNNNNN

Longjaw, Benjamin61M350M2249/19/06NegNegNNNYN

Kirkegard, Harvey60M318M2259/19/06NegNegNNNNN

Ickies, Laura38F356M2269/19/06MSSANegNNNYN

&C&"Arial,Bold"&14MRSA Point-Prevalence Study &"Arial,Regular"&10&"Arial,Bold Italic"&12Patients&"Arial,Regular"&10September 2006

AgeGender

Colonization Rate

Traditional Culture Methodn=2177.8%

Rapid PCR Methodn=21411.7%

Excluding ATUExcluding HemodialysisExcluding ICUExcluding IPMExcluding IPS

Traditional Culture Method8.2%7.3%8.8%8.7%8.4%

Rapid PCR Method12.2%9.5%12.0%9.4%12.4%

Traditional Culture MethodPCR

Excluding ATUExcluding HemodialysisExcluding ICUExcluding IPMExcluding IPSExcluding ATUExcluding HemodialysisExcluding ICUExcluding IPMExcluding IPS

3.8%2.0%1.5%1.9%1.7%5.5%1.4%1.0%1.3%1.1%

0.5%0.7%3.6%4.3%3.9%0.6%0.7%5.2%6.3%5.6%

2.2%2.7%2.1%0.6%0.6%5.0%6.1%4.7%0.6%0.6%

1.6%2.0%1.5%1.9%2.2%1.1%1.4%1.0%1.3%5.1%

8.1%7.4%8.7%8.7%8.4%12.2%9.6%11.9%9.5%12.4%

Traditional CulturePCR

MRSANegMSSADenPosNegdenNo SpecimenUnresolved

ATU2256336.1%231336.1%00

Hemodialysis739216710.4%11566716.4%00

ICU1157234.3%121224.5%10

IPM44111567.1%9465516.4%01

IPS3296387.9%235375.4%10

TOTAL18148512178.3%2419021411.2%21

ATUHemodialysisICUIPMIPS


Rapid PCR Method6.1%14.9%4.5%16.4%5.4%

&C&"Arial,Bold"&14MRSA Point-Prevalence Study&12Patient Study &"Arial,Italic"&11(IPM, IPS, ICU, ATU, Hemodialysis)&"Arial,Regular"&10September 2006

AgeGender

0

0

Colonization Rate

Overall MRSA Colonization Rates

11.1%(24/214)

8.3%(18/217)

RiskFactorsBar

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

MSSA Colonization Rate(51/217 = 23%)

2 - no specimen1 - unresolved

Traditional Culture Method

Rapid PCR Method

Departments Excluded

8.4%(15/179)

8.7%(14/161)

8.8%(17/194)

7.3%(11/150)

8.2%(15/184)

12.4%(22/177)

9.4%(15/159)

12.0%(23/192)

9.5%(14/147)

12.2%(22/181)

0

0

0

0

0

0

0

0

0

0


RiskFactorsLine

0

0

0

0

0

ATU

IPM

Hemodialysis

IPS

ICU

8.2%(15/184)

8.4%(15/179)

7.3%(11/150)

8.7%(14/161)

12.0%(23/192)

12.2%(22/181)

8.8%(17/194)

9.5%(14/147)

9.4%(15/159)

12.4%(22/177)


ATU6.1%(2/33)

Hemodialysis10.4%(7/67)

ICU4.3%(1/23)

IPM7.1%(4/56)

IPS7.9%(3/38)

0

0

0

0

0

Rapid PCR Method

ATU6.1%(2/33)


ICU4.5%(1/22)

IPM16.4%(9/55)

IPS5.4%(2/37)

RiskFactorsLineTable

Colonization Rate





Rapid PCR Method12.2%9.5%12.0%9.4%12.4%



3.8%2.0%1.5%1.9%1.7%5.5%1.4%1.0%1.3%1.1%

0.5%0.7%3.6%4.3%3.9%0.6%0.7%5.2%6.3%5.6%

2.2%2.7%2.1%0.6%0.6%5.0%6.1%4.7%0.6%0.6%

1.6%2.0%1.5%1.9%2.2%1.1%1.4%1.0%1.3%5.1%

8.1%7.4%8.7%8.7%8.4%12.2%9.6%11.9%9.5%12.4%



IPS3296387.9%IPS235375.4%10

IPM44111567.1%IPM9465516.4%01

ICU1157234.3%ICU121224.5%10

Hemodialysis739216710.4%Hemodialysis11566716.4%00

ATU2256336.1%ATU231336.1%00

TOTAL18148512178.3%2419021411.2%21



Rapid PCR Method6.1%16.4%4.5%16.4%5.4%

ICU1157234.3%ICU121224.5%10

ATU2256336.1%IPS235375.4%10

IPM44111567.1%ATU231336.1%00

IPS3296387.9%Hemodialysis11566716.4%00

Hemodialysis739216710.4%IPM9465516.4%01

TOTAL18148512178.3%2419021411.2%21

&C&"Arial,Bold"&14MRSA Prevalence Study&12Patient Study &"Arial,Italic"&11(IPM, IPS, ICU, ATU, Hemodialysis)&"Arial,Regular"&10September 2006

RiskFactorsLineTable

0

0

Colonization Rate


11.7%(25/214)

7.8%(17/217)

RiskLineTable110606

0

0

0

0

0

Overall S. aureus colonization 69/217 = 32% of which 17 / 217 +MRSA = 7.8%



7.9%(3/38)

7.1%(4/56)

4.3%(1/23)

10.4%(7/67)

6.1%(2/33)

0

0

0

0

0

Rapid PCR Method

5.4%(2/37)

16.4%(9/55)

4.5%(1/22)

16.4%(11/67)

6.1%(2/33)

Colonization Rate





Rapid PCR Method12.2%9.5%12.0%9.4%12.4%



3.8%2.0%1.5%1.9%1.7%5.5%1.4%1.0%1.3%1.1%

0.5%0.7%3.6%4.3%3.9%0.6%0.7%5.2%6.3%5.6%

2.2%2.7%2.1%0.6%0.6%5.0%6.1%4.7%0.6%0.6%

1.6%2.0%1.5%1.9%2.2%1.1%1.4%1.0%1.3%5.1%

8.1%7.4%8.7%8.7%8.4%12.2%9.6%11.9%9.5%12.4%



ATU2256336.1%231336.1%00

Hemodialysis739216710.4%11566716.4%00

ICU1157234.3%121224.5%10

IPM44111567.1%9465516.4%01

IPS3296387.9%235375.4%10

TOTAL18148512178.3%2419021411.2%21



Rapid PCR Method6.1%16.4%4.5%16.4%5.4%

Traditional Culture Method: Organism growth on blood agar plate followed by latex agglutination.Rapid PCR Method: Detects and amplifies MRSA DNA by polymerase chain reaction; able to detect live or dead organism.

Dept % ColonizationICU 4.3% (1/23)IPM 7.1% (4/56)IPS 7.9% (3/38)ATU 9.1% (3/33)Hemodialysis 10.4% (7/67)


(1 Unresolved)

(1 No specimen)

(1 No Specimen)

&C&"Arial,Bold"&14MRSA Point-Prevalence Study&12Patient Study &"Arial,Italic"&11(IPM, IPS, ICU, ATU, Hemodialysis)&"Arial,Regular"&10September 2006

&LC:IC:MRSA/mrsa2006studydatabase/srf

0

0

Colonization Rate


11.1%(24/214)

8.3%(18/217)

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

MSSA Colonization Rate(51 / 217 = 23%)



Rapid PCR Method


8.4%(15/179)

8.7%(14/161)

8.8%(17/194)

7.3%(11/150)

8.2%(15/184)

12.4%(22/177)

9.4%(15/159)

12.0%(23/192)

9.5%(14/147)

12.2%(22/181)

0

0

0

0

0

0

0

0

0

0


0

0

0

0

0

ATU

IPM

Hemodialysis

IPS

ICU

8.2%(15/184)

8.4%(15/179)

7.3%(11/150)

8.7%(14/161)

12.0%(23/192)

12.2%(22/181)

8.8%(17/194)

9.5%(14/147)

9.4%(15/159)

12.4%(22/177)


ATU9.1%(3/33)


ICU4.3%(1/23)

IPM7.1%(4/56)

IPS7.9%(3/38)

0

0

0

0

0


Rapid PCR Method

ATU6.1%(2/33)


ICU4.5%(1/22)

IPM16.4%(9/55)

IPS5.4%(2/37)

Traditional Culture MethodRapid PCR Method

0-100.0%0.0%

11-200.0%0.0%

21-308.3%8.3%

31-400.0%18.2%

41-505.6%8.3%

51-606.9%10.3%

61-7014.0%17.1%

71-809.1%11.4%

81-906.7%6.7%

91-10020.0%20.0%


Female4.3%6.5%

Male11.3%14.9%

Traditional Culture Method: Organism growth on blood agar plate followed by latex agglutination.Rapid PCR Method: Detects and amplifies MRSA DNA by polymerase chain reaction; able to detect live or dead organism.


&C&"Arial,Bold"&12MRSA Point-Prevalence Study&"Arial,Regular"&10&"Arial,Bold Italic"&12Patient Study&"Arial,Regular"&10&"Arial,Bold Italic"&11(IPM, IPS, ICU, ATU, Hemodialysis)&"Arial,Regular"&10September 2006

00

00

00

00

00

00

00

00

00

00


Rapid PCR Method

By Age

0.0%(0/5)

0.0%(0/1)

8.3%(1/12)

0.0%(0/12)

5.6%(2/36)

6.9%(2/29)

14.0%(6/43)

9.1%(4/44)

6.7%(2/30)

20.0%(1/5)

0.0%(0/1)

0.0%(0/5)

8.3%(1.12)

18.2%(2/11)

8.3%(3/36)

10.3%(3/29)

17.1%(7/41)

11.4%(5/44)

6.7%(2/30)

20.0(1/5)%

00

00

Female

Male

By Gender

6.5%(6/93)

4.3%(4/93)

14.9%(18/121)

11.3%(14/124)

Traditional Culture MethodRapid PCR MethodTraditionalPCR

0-20 Years0.0%0.0%0/60/6

21-40 Years4.2%13.0%1/243/23

41-60 Years6.2%9.2%4/656/65

>61-80 Years9.8%13.3%12/12216/120

17/21725/214


Female3.2%6.5%

Male11.3%15.3%

&C&"Arial,Bold"&12MRSA Prevalence Study&11Patient Study&"Arial,Regular"&10&"Arial,Bold Italic"&11(IPM, IPS, ICU, ATU, Hemodialysis)&"Arial,Regular"&10September 2006

00

00

00

00


Rapid PCR Method

By Age

4.2%(1/24)

0.0%(0/6)

6.2%(4/65)

9.8%(12/122)

8.6%(3/35)

6.9%(2/29)

14.0%(6/43)

9.1%(4/44)

6.7%(2/30)

20.0%(1/5)

0.0%(0/6)

13.0%(3/23)

9.2%(6/65)

13.3%(16/120)

8.6%(3/35)

10.3%(3/29)

17.1%(7/41)

11.4%(5/44)

6.7%(2/30)

20.0(1/5)%

00

00

Female

Male

By Gender

3.2%(3/93)

6.5%(6/93)

11.3%(14/124)

15.3%(19/121)


0-20 Years0.0%0.0%

21-40 Years4.2%13.0%

41-60 Years6.2%9.2%

61-80 Years10.3%15.3%

> 80 Years8.6%8.6%


Female3.2%6.5%

Male11.3%15.3%

&C&"Arial,Bold"&12MRSA Point-Prevalence Study&"Arial,Regular"&10&"Arial,Bold Italic"&12Patient Study&"Arial,Regular"&10&"Arial,Bold Italic"&11(IPM, IPS, ICU, ATU, Hemodialysis)&"Arial,Regular"&10September 2006

00

00

00

00

00


Rapid PCR Method

By Age

20.0%(1/5)

6.7%(2/30)

9.1%(4/44)

14.0%(6/43)

6.9%(2/29)

8.6%(3/35)

10.3%(9/87)

6.2%(4/65)

0.0%(0/6)

4.2%(1/24)

20.0(1/5)%

6.7%(2/30)

11.4%(5/44)

17.1%(7/41)

10.3%(3/29)

8.6%(3/35)

15.3%(13/85)

9.2%(6/65)

13.0%(3/23)

0.0%(0/6)

00

00

Female

Male

By Gender

3.2%(3/93)

6.5%(6/93)

11.3%(14/124)

15.3%(19/121)

DIABETES (Diagnosis of Diabetes or oral hypoglycemia or insulin RX)Risk FactorTraditional Culture MethodTraditional Culture MethodRapid PCR MethodRapid PCR Method

Traditional

DiabetesNegMSSAMRSAdencolonization rateDiabetes-Yes16.7%12/7222.2%16/72

Yes4020127216.7%Diabetes-No4.1%6/1455.6%8/142

No1083161454.1%

Total1485118217Prior Hosp-Yes6.1%6/9910.2%10/98

Prior Hosp-No10.2%12/11812.1%14/116

PCR

DiabetesNegPosdenUnresolvedNo specimencolonization rateLTC Stay-Yes5.3%1/195.6%1/18

Yes5616720022.2%LTC Stay-No8.6%17/19811.7%23/196

No1348142125.6%

Total1902421412Prior Abx-Yes10.6%7/6612.5%8/64

Prior Abx-No7.3%11/15110.7%16/150

PRIOR HOSP (inpt stay within last year)Dialysis-Yes10.1%8/7917.9%14/78

TraditionalDialysis-No7.2%10/1387.4%10/136

Prior HospNegMSSAMRSAdencolonization rate

Yes70236996.1%

No78281211810.2%

Total1485118217

PCR

Prior HospNegPosdenUnresolvedNo specimencolonization rate

Yes8810981010.2%

No102141160212.1%

Total1902421412

LONG-TERM CARE STAY (Any resident facility within last year)

Traditional

LTC StayNegMSSAMRSAdencolonization rate

Yes1351195.3%

No13546171988.6%

Total1485118217

PCR

LTC StayNegPosdenUnresolvedNo specimencolonization rate

Yes17118105.6%

No173231960211.7%

Total1902421412

PRIOR ABX (prior ABX, Rx or empiric within last 6 wks; excludes surgical prophylaxis)

Traditional

Prior AbxNegMSSAMRSAdencolonization rate

Yes54576610.6%

No9446111517.3%

Total1485118217

PCR

Prior AbxNegPosdenUnresolvedNo specimencolonization rate

Yes568641112.5%

No134161500110.7%

Total1902421412

DIALYSIS (Hemodialysis)

Traditional

DialysisNegMSSAMRSAdencolonization rate

Yes472487910.1%

No10127101387.2%

Total1485118217

PCR

DialysisNegPosdenUnresolvedNo specimencolonization rate

Yes6414780117.9%

No12610136117.4%

Total1902421412

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00


Rapid PCR Method

Overall Colonization Rates by Risk Factors

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00


Rapid PCR Method

00

00

00


Rapid PCR Method

Diabetes

00

00

00


Rapid PCR Method

Prior Hospitalization

00

00

00


Rapid PCR Method

Long-Term Care Stay

00

00

00


Rapid PCR Method

Prior Antibiotic

00

00

00


Rapid PCR Method

Hemodialysis


Traditional


Yes4120117215.3%Diabetes-No4.1%6/1455.6%8/142

No1083161454.1%


Prior Hosp-No10.2%12/11812.9%15/116

PCR


Yes5517720023.6%LTC Stay-No8.1%16/19812.2%24/196

No1348142125.6%


Prior Abx-No7.3%11/15111.3%17/150




Yes71235995.1%

No78281211810.2%

Total1495117217

Risk FactorTraditional Culture MethodRapid PCR MethodTraditional Culture MethodRapid PCR Method

PCRDiabetes15.3%23.6%11/7217/72

Prior HospNegPosdenUnresolvedNo specimencolonization ratePrior Hosp5.1%10.2%5/9910/98

Yes8810981010.2%LTC Stay5.3%5.6%1/191/18

No101151160212.9%Prior Abx9.1%12.5%6/668/64

Total1892521412Dialysis10.1%19.2%8/7915/78

LONG-TERM CARE STAY (Any resident facility within last year)Risk FactorTraditional Culture MethodRapid PCR MethodTraditional Culture MethodRapid PCR Method

TraditionalDiabetes4.1%5.6%6/1458/142

LTC StayNegMSSAMRSAdencolonization ratePrior Hosp10.2%12.9%12/11815/116

Yes1351195.3%LTC Stay8.1%12.2%16/19824/196

No13646161988.1%Prior Abx7.3%11.3%11/15117/150

Total1495117217Dialysis6.5%7.4%9/13810/136

PCR


Yes17118105.6%

No172241960212.2%

Total1892521412


Traditional


Yes5556669.1%

No9446111517.3%

Total1495117217

PCR

Prior AbxNegPosdenUnresolvedNo specimencolonization rate

Yes568641112.5%

No133171500111.3%

Total1892521412


Traditional


Yes472487910.1%

No1022791386.5%

Total1495117217

PCR


Yes6315780119.2%

No12610136117.4%

Total1892521412

&C&"Arial,Bold"&12MRSA Point-Prevalence StudyPatient Study&"Arial,Regular"&10&"Arial,Bold Italic"&11(IPM, IPS, ICU, ATU, Hemodialysis)&"Arial,Regular"&10September 2006

&L&"Arial,Italic"&8C:IC:MRSA:mrsa2006studydatabase/srf

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00


Rapid PCR Method

Overall Colonization Rates by Risk Factors

6.5%9/138

4.1%6/145

15.3%11/72

5.1%5/99

10.2%12/118

5.3%1/19

8.1%16/198

9.1%6/66

7.3%11/151

10.1%8/79

7.4%10/136

5.6%8/142

23.6%17/72

10.2%10/98

12.9%15/116

5.6%1/18

12.2%24/196

12.5%8/64

11.3%17/150

19.2%15/78

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00


Rapid PCR Method

00

00

00


Rapid PCR Method

Diabetes

00

00

00


Rapid PCR Method


00

00

00


Rapid PCR Method

Long-Term Care Stay

00

00

00


Rapid PCR Method

Prior Antibiotic

00

00

00


Rapid PCR Method

Hemodialysis

00

00

00

00

00


Rapid PCR Method

Overall Colonization Rates with Risk Factors

15.3%(11/72)

5.1%(5/99)

5.3%(1/19)

9.1%(6/66)

10.1%(8/79)

23.6%(17/72)

10.2%(10/98)

5.6%(1/18)

12.5%(8/64)

19.2%(15/78)

00

00

00

00

00


Rapid PCR Method

Colonization Rates with No Risk Factors

6.5%(9/138)

7.3%(11/151)

8.1%(16/198)

10.2%(12/118)

4.1%(6/145)

7.4%(10/136)

11.3%(17/150)

12.2%(24/196)

12.9%(15/116)

5.6%(8/142)


Traditional


Yes4120117215.3%Diabetes-No4.1%6/1455.6%8/142

No1083161454.1%


Prior Hosp-No10.2%12/11812.9%15/116

PCR


Yes5517720023.6%LTC Stay-No8.1%16/19812.2%24/196

No1348142125.6%


Prior Abx-No7.3%11/15111.3%17/150




Yes71235995.1%

No78281211810.2%

Total1495117217

Risk FactorTraditional Culture MethodRapid PCR MethodTraditional Culture MethodRapid PCR Method

PCRDiabetes15.3%23.6%11/7217/72

Prior HospNegPosdenUnresolvedNo specimencolonization ratePrior Hosp5.1%10.2%5/9910/98

Yes8810981010.2%LTC Stay5.3%5.6%1/191/18Risk FactorTraditional Culture MethodRapid PCR Method

No101151160212.9%Prior Abx9.1%12.5%6/668/64Diabetes15.3%(11/72)23.6%(17/72)

Total1892521412Dialysis10.1%19.2%8/7915/78Prior Hosp5.1%(5/99)10.2%(10/98)

LTC Stay5.3%(1/19)5.6%(1/18)

Prior Abx9.1%(6/66)12.5%(8/64)

LONG-TERM CARE STAY (Any resident facility within last year)Risk FactorTraditional Culture MethodRapid PCR MethodTraditional Culture MethodRapid PCR MethodDialysis10.1%(8/79)19.2%(15/78)

TraditionalNo Diabetes4.1%5.6%6/1458/142

LTC StayNegMSSAMRSAdencolonization rateNo Prior Hosp10.2%12.9%12/11815/116

Yes1351195.3%No LTC Stay8.1%12.2%16/19824/196

No13646161988.1%No Prior Abx7.3%11.3%11/15117/150

Total1495117217No Dialysis6.5%7.4%9/13810/136

PCR


Yes17118105.6%

No172241960212.2%

Total1892521412


Traditional


Yes5556669.1%

No9446111517.3%No Risk FactorsTraditional Culture MethodRapid PCR Method

Total1495117217No Diabetes4.1%(6/145)5.6%(8/142)

No Prior Hosp10.2%(12/118)12.9%(15/116)

PCRNo LTC Stay8.1%(16/198)12.2%(24/196)

Prior AbxNegPosdenUnresolvedNo specimencolonization rateNo Prior Abx7.3%(11/151)11.3%(17/150)

Yes568641112.5%No Dialysis6.5%(9/138)7.4%(10/136)

No133171500111.3%

Total1892521412


Traditional


Yes472487910.1%

No1022791386.5%

Total1495117217

PCR


Yes6315780119.2%

No12610136117.4%

Total1892521412

&C&"Arial,Bold"&12MRSA Point-Prevalence StudyPatient Study&"Arial,Regular"&10&"Arial,Bold Italic"&11(IPM, IPS, ICU, ATU, Hemodialysis)&"Arial,Regular"&10September 2006

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00


Rapid PCR Method

00

00

00


Rapid PCR Method

Diabetes

00

00

00


Rapid PCR Method


00

00

00


Rapid PCR Method

Long-Term Care Stay

00

00

00


Rapid PCR Method

Prior Antibiotic

00

00

00


Rapid PCR Method

Hemodialysis

00

00

00

00

00


Rapid PCR Method

Colonization Rates with Risk Factors

10.1%(8/79)

9.1%(6/66)

5.3%(1/19)

5.1%(5/99)

15.3%(11/72)

19.2%(15/78)

12.5%(8/64)

5.6%(1/18)

HEALTHCARE-ASSOCIATED MRSA Emerging Problems Clinical Patterns Strategies for Control Ed Septimus,...

Documents

Transcript of HEALTHCARE-ASSOCIATED MRSA Emerging Problems Clinical Patterns Strategies for Control Ed Septimus,...