Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus

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      Observational and microbiological data were collected from the patients and environment of a male general surgical ward over a period of 27 months from January 1998. Isolates of methicillin-resistant Staphylococcus aureus (MRSA) from patients and environment were typed by antibiogram, bacteriophage and pulsed field gel electrophoresis of chromosomal DNA. In September 1999, an intervention was put in place which included increasing the domestic cleaning time by 57 hours per week, with emphasis on removal of dust by vacuum cleaning, and allocation of responsibility for the routine cleaning of shared medical equipment.
      From January 1998 to September 1999, despite standard infection control measures (emphasis on hand hygiene, isolation of affected patients and staggered closure and cleaning of ward bays), 69 patients acquired a strain of E-MRSA16. This strain was also widespread in the ward environment. Typing confirmed that isolates from patients and environment were indistinguishable from one another and that the outbreak was due to a single strain. This strain was responsible for postoperative infection in approximately one third of the patients who acquired it. In the six months following the intervention, only three patients were colonized with the outbreak MRSA and monthly surveys failed to detect this strain in the environment. Thorough and continuous attention to ward hygiene and removal of dust was needed, to terminate a prolonged outbreak of MRSA infection on a general surgical ward, in addition to standard infection control measures. Control of hospital-acquired infection with MRSA requires a combination of measures, none of which are completely effective in isolation.


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        • Pittet D
        • Hugonnet S
        • Harbarth S
        Effectiveness of a hospital-wide programme to improve compliance with hand hygiene.
        Lancet. 2000; 356: 1307-1312
        • Dancer SJ
        Mopping up hospital infection.
        J Hosp Infect. 1999; 43: 85-100
      1. The NHS Plan. July 2000, CM, 4818–4821.

        • Ayliffe GAJ
        • Collins BJ
        • Lowbury EJL
        • Babb JR
        • Lilly HA
        Ward floors and other surfaces as reservoirs of hospital infection.
        J Hyg Camb. 1967; 65: 515-536
        • Maki DG
        • Alvarado CJ
        • Hassemer CA
        • Zilz MA
        Relation of the inanimate hospital environment to endemic nosocomial infection.
        New Eng J Med. 1982; 307: 1562-1566
        • Collins BJ
        The hospital environment: how clean should a hospital be?.
        J Hosp Infect. 1988; 11: 53-56
      2. Plowman, R, Graves, N, Griffin, M, et al., The Socio-economic burden of hospital acquired infection, England, MWL Print Group Ltd

      3. J Hosp Infect. 1998; 39: 253-290
      4. PHLS Standard Operating Procedure – Investigation of specimens for screening for MRSA. Reference number BSOP29 issue no 1 5/2/99.

        • Macfarlane L
        • Walker J
        • Borrow R
        • Oppenheim BA
        • Fox AJ
        Improved recognition of MRSA case clusters by the application of molecular subtyping by pulsed-field gel electrophoresis.
        J Hosp Infect. 1999; 41: 29-37
        • Tenover FC
        • Arbeit RD
        • Goering RV
        Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: Criteria for bacterial strain typing.
        J Clin Microbiol. 1995; 33: 2233-2239
        • Lacey RW
        • Barr KW
        • Barr VE
        • Inglis TJ
        Properties of methicillin-resistant Staphylococcus aureus colonizing patients in a burns unit.
        J Hosp Infect. 1986; 7: 137-148
        • Duckworth GJ
        • Jordens JZ
        Adherence and survival properties of an epidemic methicillin-resistant strain of Staphylococcus aureus compared with those of methicillin-sensitive strains.
        J Med Microbiol. 1990; 32: 195-200
        • Hirai Y
        Survival of bacteria under dry conditions; from a viewpoint of nosocomial infection.
        J Hosp Infect. 1991; 19: 191-200
        • Wagenvoort JHT
        • Sluijsmans W
        • Penders RJR
        Better environmental survival of outbreak vs. sporadic MRSA isolates.
        J Hosp Infect. 2000; 45: 231-234
        • Boyce JM
        • Potter-Bynoe G
        • Chenevert C
        • King T
        Environmental contamination due to methicillin-resistant Staphylococcus aureus: Possible infection control implications.
        Infect Control Hosp Epidemiol. 1997; 18: 622-627
        • Zafar AB
        • Gaydos LA
        • Furlong WB
        • Nguyen MH
        • Mennonna PA
        Effectiveness of infection control program in controlling nosocomial Clostridiumdifficile.
        Am J Infect Control. 1998; 26: 588-593
        • Johnson Z
        • Fitzpatrick P
        • Hayes C
        National survey of MRSA: Ireland 1995.
        J Hosp Infect. 1997; 35: 175-184
        • Morgan M
        • Evans-Williams D
        • Salmon R
        • Hosein I
        • Looker DN
        • Howard A
        The population impact of MRSA in a country: the national survey of MRSA in Wales 1997.
        J Hosp Infect. 2000; 44: 227-239
        • Blythe D
        • Keenlyside D
        • Dawson SJ
        • Galloway A
        Environmental contamination due to methicillin-resistant Staphylococcus aureus (MRSA).
        J Hosp Infect. 1998; 38: 67-70
        • Wilcox MH
        • Dave J
        The cost of hospital-acquired infection and the value of infection control.
        J Hosp Infect. 2000; 45: 81-84