Parent Skin Cleansing Prior to Infant Contact in NICU Important to Reduce Staph Infections

MedicalResearch.com Interview with:
“Bart Infant” by Bart Everson is licensed under CC BY 2.0Gwen M. Westerling, BSN, RN, CIC
Infection Preventionist
Helen DeVos Children’s Hospital

MedicalResearch.com: What is the background for this study?

Response: The setting of this study is a Level III Neonatal Intensive Care Unit (NICU) with 106 beds.

In 2016, an increase in Hospital Acquired Infections (HAI) was noted in the Neonatal Intensive Care Unit (NICU) caused by Staphylococcus aureus (SA) through diligent Infection Prevention Surveillance. When we reviewed the literature we found the SA is a common skin colonizer and can be a problem for neonates with immature skin and immune systems.

Staphylococcus aureus is easily transmitted through direct contact with skin, the contaminated hands of health care workers, the environment and equipment. We also found one study that listed skin to skin care as a risk factor for acquisition of SA. Before we saw the increase in infections some process changes occurred in our NICU that included increased skin to skin care, meaningful touch between neonates and parents, and two person staff care. We hypothesized that the process changes were exposing neonates to increased amounts of Staphylococcus aureus and contributing to the increase in infections.

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MRSA Contamination of Home and Pets May Contribute To Reinfection and Resistance

MedicalResearch.com Interview with:

Mr-Jonathan-Shahbazian

Mr. Shahbazian

Mr. Jonathan Shahbazian, MPH
Johns Hopkins Bloomberg School of Public Health
Baltimore

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study was designed to investigate risk factors for drug resistance in MRSA found in dust on surfaces in the home. We undertook this investigation because we were concerned first that people living in the home could pick up MRSA from these surfaces, and second, that if they picked up drug-resistant MRSA, it would be more difficult to treat them.

Our main finding was that use of antibiotics by either people or pets in the home, as well as use of biocidal cleaning products, was associated with multidrug resistance (MDR) in home MRSA. This study is the first to report that use clindamycin in either humans or domestic animals was not associated with risk of MDR in the home environment.

We also found that mupirocin treatment was associated with a slight increase in mupirocin resistance in the household environment, which could complicate decolonization efforts that rely on use of nasal mupirocin ointment. We found that 100% of our MRSA isolates from rural homes were MDR, suggesting living in a rural household may be a risk factor. We also found the presence of domestic pets was associated with MDR MRSA in the home environment while the presence of unwanted pests, such as mice or cockroaches, was associated with non-MDR MRSA strains at the three-month visit.

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Hospital and Separate Dialysis Units Have Similar MRSA Rates

MedicalResearch.com Interview with:
Georg Schlieper, MD

MVZ DaVita Rhein-Ruhr
Duesseldorf, Germany

MedicalResearch.com: What is the background for this study?

Response: Methicillin-resistant Staphylococcus aureus (MRSA) colonization in hemodialysis patients is associated with higher risk for systemic infection. Recent hospitalization and temporary dialysis access are known risk factors for MRSA colonization. Whether MRSA colonization rates in hospital-based dialysis centers differ from separate dialysis centers is unknown. Data on MRSA decolonization strategies in hemodialysis patients are scarce.

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Risk Factors For MRSA Infections After Discharge Identified

MedicalResearch.com Interview with:
Dr. Lauren Epstein M.D., M.S.

Division of Healthcare Quality Promotion Epidemic Intelligence Service
Centers for Disease Control and Prevention
Atlanta, GA, USA 

Medical Research: What is the background for this study? What are the main findings?

Dr. Epstein: Nearly 80% of methicillin resistant Staphylococcus aureus (MRSA) infections occurs outside of the hospitals and mostly among individuals with a recent hospitalization.  However, risk factors for MRSA infections among patients recently discharged from an acute care hospital have not been well explored.   The goal of this study was to identify modifiable risk factors associated with MRSA infections among recently discharged patients to target future prevention efforts.  We found that patients with a history of MRSA colonization, chronic wounds, invasive devices at discharge such as central lines and surgical drains, and those discharged from a hospital to a nursing home are at increased risk of invasive MRSA infections within 12 weeks after hospital discharge.

Medical Research: What should clinicians and patients take away from your report?

Dr. Epstein: MRSA infections are a significant public health concern and patients remain at risk for MRSA infections following acute care hospitalizations, especially in the 3 months following discharge from an acute care facility.

Patients with a prior history of MRSA colonization are at increased risk for MRSA infections following an acute care hospitalization.  In addition, patients who have an invasive device (such as a central line or surgical drain) or a chronic wound at the time of discharge from a hospitalization are at increased risk of MRSA infection following discharge.  Finally, patients who are discharged to a long term care facility, regardless of other risk factors, are at increased risk of MRSA infection.

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MRSA Persistence Linked With Household Members and Pets

MedicalResearch.com Interview with:
Valerie Cluzet, MD
Hospital of the University of Pennsylvania
Division of Infectious Diseases
Philadelphia, PA 19104

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Cluzet: MRSA is a major cause of skin and soft tissue infection (SSTI) in the community and we know that colonization is an important risk factor for subsequent infection. Past studies have calculated duration of colonization based on colonization at hospital admission or focused on populations not representative of the typical community-dwelling patient. We wanted to identify the factors associated with duration of colonization in a typical patient that clinicians would see (i.e. adults and children presenting to ambulatory setting with a MRSA SSTI), so that the findings would be generalizable and relevant to their practice. In addition, there has been an increasing focus on the role of the household in transmission of MRSA, so wanted to specifically examine that in a longitudinal, systematic way.

There are a few major points that emerged from our study.

1) The first is that the duration of colonization after treatment for a methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) is relatively short, but there is a significant subset of patients (approximately 20%) who will have persistent colonization.

2) We also found that treatment of the MRSA SSTI with clindamycin was associated with shorter duration of colonization, an association we did not see with other MRSA-active agents.

3) Finally, this study highlights the potential role of MRSA colonization among household members as a contributing factor in duration of colonization in patients.
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Novel Vaccine Fights MRSA Infections

Dr. Michael Yeaman Ph.D. Professor of Medicine, Infectious Disease Specialist Chief, Division of Molecular Medicine David Geffen School of Medicine at UCLA Los Angeles Biomedical Research Institute at Harbor-UCLA Medical CenterMedicalResearch.com Interview with:
Dr. Michael Yeaman Ph.D.

Professor of Medicine, Infectious Disease Specialist
Chief, Division of Molecular Medicine
David Geffen School of Medicine at UCLA
Los Angeles Biomedical Research Institute
Harbor-UCLA Medical Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Yeaman: In the U.S. and around the globe, skin and soft tissue infections caused by
methicillin-resistant Staphylococcus aureus (MRSA) continue to endanger the
health and lives of patients and otherwise healthy individuals. Treatment is
difficult because MRSA is resistant to many antibiotics, and the infections
can recur, placing family members and other close contacts at risk of
infection.

Infectious disease specialists at the Los Angeles Biomedical Research
Institute at Harbor-UCLA Medical Center (LA BioMed) tested a new
investigational vaccine, NDV-3, and found it holds new hope for preventing
or reducing the severity of infections caused by the “superbug” MRSA.

In the study, which was published Dec. 8 in the Proceedings of the National
Academy of Sciences USA, the researchers reported that NDV-3, employing the
recombinant protein Als3, can mobilize the immune system to fight off MRSA
skin infections in an experimental model. The researchers found the vaccine
works by enhancing molecular and cellular immune defenses of the skin in
response to MRSA and other S. aureus bacteria in disease models.

This is the first published study to demonstrate the effectiveness of a
cross-kingdom recombinant vaccine against MRSA skin infections. NDV-3 is
unique as it is the first vaccine to demonstrate it can be effective in
protecting against infections caused by both S. aureus and the fungus
Candida albicans. NDV-3 represents a novel approach to vaccine design that
pioneers an approach termed convergent immunity.

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MRSA Strains Can Affect Humans and Livestock

Melissa Ward PhD CIIE Research Fellow Centre for Immunity, Infection and Evolution University of EdinburghMedicalResearch.com Interview with:
Melissa Ward PhD
CIIE Research Fellow Centre for Immunity, Infection and Evolution
University of Edinburgh

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Ward: We studied a strain of the bacterium Staphylococcus aureus known as CC398, which can colonise and cause MRSA infection in humans and livestock. People and animals generally harbour genetically distinct variants of CC398, but we found human isolates, including a small number from Scottish hospitals, which were more similar to the livestock strains. Such isolates were resistant to a larger number of antibiotics than the CC398 strain which typically circulates in humans. By looking at the genetic sequences of strains from across the globe, we also inferred that CC398 has entered Scotland on multiple occasions.

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ID Week 2014: Universal MRSA Screening May Be Too Expensive To Implement

https://medicalresearch.com/cost-of-health-care/id_week_14_universal_mrsa_screening_may_be_too_expensive_to_implement/8166/Medical Research’s Interview with:
James A. McKinnell, MD
Los Angeles Biomedical Research Institute

 


Medical Research: What are the main findings of the study?

Dr. McKinnell: Numerous experts and policy makers have called for hospitals to screen patients for methicillin-resistant Staphylococcus aureus (MRSA) infections and isolate anyone testing positive to prevent the spread of these so-called “Superbugs” in healthcare settings. Several states have enacted laws requiring patients be screened for MRSA upon admission.

We conducted two studies, both of which were presented as abstracts at IDWeek, the annual scientific meeting for infectious disease specialists, which found universal MRSA screening and isolation of high-risk patients will help prevent MRSA infections but may be too economically burdensome for an individual hospital to adopt.

Researchers at Los Angeles Biomedical Research Institute, the University of California, Irvine and John Hopkins University examined the cost of a hospital infection prevention strategy that tested all patients for MRSA and then took precautions to avoid contact with potential carriers. We found that using the traditional method of testing for MRSA in the nose, or nares surveillance, and then isolating MRSA carriers prevented nearly three MRSA infections. But it cost the hospital $103,000 per 10,000 hospital admissions. More extensive screening, through the use of other testing methods, which included PCR-based screening, prevented more infections, but increased the cost.

In the second study, we also evaluated the cost of a hospital infection prevention strategy that targeted high-risk patients. Again, we found the costs of the program exceeded the potential savings to the hospital that would be generated by preventing MRSA infections.

We found nares screening and isolation of high-risk patients prevented fewer than one infection (0.6) per 1,000 high-risk admissions to the hospital and created a financial loss of $36,899 for the hospitals. Using more extensive MRSA screening – which included nares, pharynx and inguinal folds screening – prevented slightly more infections (0.8 infections per 1,000 high-risk admissions), according to the study. But our abstract reported an even larger financial loss of $51,478 with the more extensive screening. Continue reading

Bacteria Causing Eye Infections Increasingly Resistant To Common Antibiotics

Ronald C Gentile, MD, FACS, FASRS Professor of Ophthalmology Chief, Ocular Trauma Service (Posterior Segment) Surgeon Director The New York Eye and Ear Infirmary of Mount Sinai New York, NY 10003 President: operationrestorevision.orgMedicalResearch.com Interview with
Ronald C Gentile, MD, FACS, FASRS
Professor of Ophthalmology
Chief, Ocular Trauma Service (Posterior Segment)
Surgeon Director
The New York Eye and Ear Infirmary of Mount Sinai
New York, NY 10003
President: operationrestorevision.org

Medical Research: What are the main findings of the study?

Dr. Gentile: We had three main findings in our study on the microbiological spectrum and antibiotic sensitivity in endophthalmitis over the past twenty- five years at the New York Eye and Ear Infirmary of Mount Sinai.

First Finding: The first main finding of the study was that there has not been any major change in the types of organisms causing endophthalmitis over the past 25 years. The most common cause of endophthalmitis in the study was bacteria, 95%, with most, 85%, being Gram-positive bacteria. The most prevalent organisms isolated were coagulase-negative staphylococcus, making up about 40% of the cases. This was followed by Streptococcus viridans species in about 12% and Staphylococcus aureus in about 11%. Gram-negative organisms accounted for about 10% and fungi for about 5%.

Second Finding: The second main finding of the study was that the current empiric intravitreal antibiotics used for treating endophthalmitis, vancomycin and ceftazidime, continue to be an excellent choice. The overwhelming majority of microorganisms causing endophthalmitis are susceptible to this combination. Over 99% of the Gram-positive isolates were susceptible to the vancomycin and about 92 percent of the Gram-negative isolates were susceptible to ceftazidime.

Third Finding: The third main finding of the study was that there was increasing microbial resistance to eight antibiotics including cefazolin, cefotetan, cephalothin, clindamycin, erythromycin, methicillin/oxacillin, ampicillin, ceftriaxone and decreasing microbial resistance to three antibiotics including gentamicin, tobramycin, and imipenem. For example, Staph Aureus isolates resistant to methicillin increased from 18% in the late 1980s to just over 50% this past decade while gentamicin-resistance endophthalmitis isolates decreased during the same time period from 42% to 6%.

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MRSA Also Common At Body Sites Other Than Nose

dr_kyle_popovichMedicalResearch.com Interview with:
Kyle J. Popovich, MD, MS
Rush University Medical Center
Stroger Hospital of Cook County, Chicago, Illinois

 

Medical Research: What are the main findings of the study?

Dr. Popovich: Colonization with methicillin-resistant Staphylococcus aureus (MRSA) at body sites outside the nares was common, with more than half of all colonized individuals having MRSA colonization in the rectal or groin areas.  Resistance to mupirocin was uncommon and molecular testing showed no signs of resistance to chlorhexidine gluconate.
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MRSA Infections Vary Dramatically Among Academic Medical Centers

Dr. Brad Spellberg MD Associate Program Director, Internal Medicine Training Program Professor of Medicine, David Geffen School of Medicine at UCLA Division of General Internal MedicineMedicalResearch.com Interview with:
Dr. Brad Spellberg MD
Associate Program Director
Internal Medicine Training Program
Professor of Medicine, David Geffen School of Medicine at UCLA, Division of General Internal Medicine

MedicalResearch: What are the main findings of the study?

Dr. Spellberg:  The rates of community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) varied dramatically among academic medical centers in California, New York, Illinois and North Carolina, suggesting there is not a uniform change in the “national epidemic” of the “superbug” that has generated extensive public health concern over the past decade, according to a new study.The study surveyed hospital records of 4,171 cases of MRSA and MRSA-related infections between 2008 and 2011 in five medical centers located in Los
Angeles, San Francisco, Chicago, New York City and Raleigh-Durham, NC.The rates of MRSA acquired in the community declined 57% from 2008-2011 in
the Los Angeles medical center. In contrast, CO-MRSA rates tripled at the
New York medical center, while the rates remained stable in San Francisco,
Chicago and Raleigh-Durham.
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MRSA and Nursing Home Admission Denials

Courtney Reynolds, PhD Medical Scientist Training Program University of California Irvine, School of MedicineMedicalResearch.com Interview with:
Courtney Reynolds, PhD
Medical Scientist Training Program
University of California Irvine, School of Medicine


MedicalResearch.com: What are the main findings of the study?

Dr. Reynolds: Our survey of factors influencing admission to 13 nursing homes in Orange County, California showed that MRSA carriers are denied admission more often than non-carriers, even after accounting for other important factors such as insurance status, required level of care and previous experience at the facility. In 80% of cases where MRSA carriage was responsible for denial of admission, nursing home administrators cited a lack of available single or cohort (MRSA only) rooms to accommodate these potential residents.
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MRSA: No Association with Number of Deliveries and Risk of Infection

MedicalResearch.com Interview with:
Dr. Andrea Parriott MPH, PhD
Department of Epidemiology
Fielding School of Public Health
University of California Los Angeles

MedicalResearch.com: What are the main findings of the study?

Dr. Parriott:  We wanted to know whether hospital and provider volume (i.e. the number of deliveries performed by each hospital and provider per quarter) and
cesarean section rates were predictors of the risk of methicillin-resistant
Staphylococcus aureus (MRSA) infection before discharge from the hospital
(after delivering a baby). We did not find an association between any of
these variables and risk of MRSA infection.
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Antibiotic-Resistant Bacteria and Universal Glove and Gown Use

Anthony Harris, MD, MPH Department of Epidemiology and Public Health Professor University of Maryland School of Medicine Acting Medical Director of Infection Control University of Maryland Medical CenterMedicalResearch.com Interview with:
Anthony Harris, MD, MPH
Department of Epidemiology and Public Health
Professor University of Maryland
School of Medicine
Acting Medical Director of Infection Control
University of Maryland Medical Center

 

 

MedicalResearch.com: What are the main findings of the study?

Dr. Harris: The aim of the study was to understand if wearing disposable gowns and gloves for all patient contact in the ICU could help prevent the spread of MRSA and similar antibiotic-resistant bacteria.

Secondarily we wanted to make sure this type of patient isolation did not result in any harm to patients. The results of the study were that gowns and gloves worn by healthcare workers for contact with all patients in the ICU did not decrease the number of patients who acquired VRE but did decrease MRSA about 40 percent.  Also, wearing gloves and gowns did not adversely impact patient care.  For our goal of studying all types of infection, we did not find a benefit to universal gown and glove use. However, for transmission of MRSA alone, the intervention decreased transmission by about 40 percent. Although previous studies have showed isolation is associated with falls, bed sores and other adverse events, we found gowns and gloves did not produce more of these negative events.
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MRSA: Number of Infections Still Increasing in Children

MedicalResearch.com Interview with:
Dr. Martha Iwamoto, MD, MPH
Centers for Disease Control and Prevention, Atlanta, Georgia;

MedicalResearch.com: What are the main findings of the study?

Dr. Iwamoto: We have been successful in decreasing invasive MRSA infections among infants younger than 3 months, mostly due to declines in hospital –onset infections in NICUs. However, more needs to be done among pediatric patients older than 3 months, especially those in the community settings and without recent healthcare exposures.
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