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02-04-2012 | Surgery | Article

MRSA cases infrequently followed up in some parts of Europe


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MedWire News: The majority of European hospitals perform incidence surveillance for methicillin-resistant Staphylococcus aureus (MRSA), but far fewer conduct active follow up when cases are detected, show data presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in London, UK, this week.

The data arise from an online questionnaire sent to members of European infection prevention and control (IPC) societies, asking them about their MRSA bacteremia-prevention practices.

Michael Borg (University of Malta, Msida) reported that 223 replies from IPC doctors or nurses in regional or academic hospitals located in 29 European countries were received.

MRSA bacteremia rates at responding hospitals were below 5% in 105 hospitals, ranged from 5-20% in 47 hospitals, and were above 20% in 71 hospitals.

Borg and team found that 90% of hospitals with MRSA levels below 5% performed daily MRSA incidence surveillance, compared with 72% of hospitals with MSRA levels above 20%, a difference that was statistically significant.

Furthermore, root-cause analysis of MRSA bacteremias was carried out in significantly more hospitals with low MRSA infection rates, compared with those with high infection rates, at 60% versus 19%.

Borg pointed out that there were considerable differences in practices across Europe. In the UK and Ireland, 100% of hospitals performed MRSA surveillance, and 80% conducted root-cause analyses when required. By contrast, only 60% of southern European countries performed surveillance and just 20% did root-cause analyses. In central and eastern Europe, surveillance levels were high, at 92%, but only 25% of hospitals followed up cases of MRSA bacteremia with root-cause analysis.

The researchers also assessed hospitals' venous catheter care policies. They found that the proportion of hospitals with policies for the insertion and maintenance of peripheral and central venous catheters did not correlate with MRSA prevalence.

However, hospitals that performed competence assessment of their personnel's ability to insert and maintain central and venous lines had significantly lower MRSA rates than those that did no such assessment.

Central venous catheter care bundles - shown to be effective in MRSA prevention in the USA - were in place in 39% to 46% of hospitals and did not correlate with MRSA prevalence. Among the hospitals providing these bundles, around 60% to 72% documented compliance with the care bundle, but just 19% to 25% of them performed bundle audit and feedback at least every 6 months.

Borg said the findings show "there is a gap between having an MRSA surveillance program in place and then using the data to actually make a change. It also seems that in the higher prevalence hospitals, this gap is even higher."

He concluded: "We need more active and more effective infection prevention interventions to reduce MRSA bacteremias in European hospitals."

However, "it is clear that what works in one country doesn't work in another."

ECCMID President, Jonathan Cohen told MedWire News it may not be as simple as that though. "We forget in this country [the UK] what a powerful vehicle for change the NHS [National Health Service] is… and that system does not exist in other European countries. That means you are much more dependent on local action by local microbiologists or physicians, which may be patchy. It's not that they don't know about it [the need to implement IPC policies], but the structures do not allow them to make it happen.

"Unless you put in place a legal framework, which is not going to happen, change needs to come about by education, not just education of microbiology and infectious diseases specialists, but education of pharmacists, hospital administrators, and other staff."

By Laura Cowen

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