Combatting Resistant Infections in Hospitals: Strategies for Patient Safety

A group of five medical organizations has published updated recommendations for the prevention of transmission and infection of methicillin-resistant Staphylococcus aureus , known as MRSA. MRSA causes approximately 10% of hospital-acquired infections in the United States and such infections are associated with an increased risk of death. Certain infections caused by MRSA increased by up to 41% during the pandemic after declining in previous years.

Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals provides practical, evidence-based recommendations to prevent the spread of MRSA and reduce the risk of MRSA infection. The document, published in the journal Infection Control & Hospital Epidemiology , is the most recently updated guideline in the series known collectively as the Compendium.

“The enormous pressure placed on healthcare during the pandemic may have contributed to the observed increase in some hospital infections. We have data showing that MRSA infections are increasing,” said David Calfee, MD, lead author of the updated guideline and editor of ICHE, the journal of the Society for Healthcare Epidemiology of America . “The evidence informing these recommendations shows that we can be successful in preventing transmission and infection. “We can go back to pre-2020 rates and then do even better.”

The updated recommendations elevate antimicrobial stewardship, an effort focused on improving how antibiotics are prescribed and used , from an "additional practice" to an "essential practice," meaning all hospitals should do it. When someone who is colonized with MRSA is treated with antibiotics for another infection, they may be at higher risk of developing an MRSA infection and may be more likely to transmit MRSA to others. Avoiding unnecessary antibiotic use can decrease these and other risks associated with antibiotic use, such as C. difficile infection.

Essential practices

The recommendation to administer prophylaxis according to evidence-based standards and guidelines was modified to emphasize that antimicrobial prophylaxis should be discontinued at the time of surgical closure in the operating room.
The use of parenteral and oral antibiotics prior to elective colorectal surgery is now considered an essential practice . This recommendation was included in the 2014 document, but was an ancillary recommendation. This recommendation was elevated to its own recommendation for greater emphasis.
Reclassified decolonization of surgical patients with an antistaphylococcal agent for cardiothoracic and orthopedic procedures from an additional approach to an essential practice.
The use of vaginal preparation with antiseptic solution prior to delivery by cesarean section and hysterectomy was added as an essential practice.
Intraoperative antiseptic wound washing reclassified from an additional approach to an essential practice. However, this approach should only be used when the sterility of the antiseptic can be guaranteed and maintained.
Monitoring of blood glucose levels during the immediate postoperative period for all patients was modified (1) to emphasize the importance of this intervention regardless of a known diagnosis of diabetes mellitus, (2) to raise the level of evidence to " high" for all procedures and (3) to reduce the target glucose level from <180 mg/dL to 110–150 mg/dL.
Reclassified use of packages to promote compliance with best practices from Unresolved to Essential Practice. The discussion on the use of checklists and packets was combined for this recommendation.
Observation and review of operating room personnel and the operating room care environment and central sterile reprocessing were reclassified from an additional focus to an essential practice.

Additional approaches

The recommendation to perform a surgical site infection (SSI) risk assessment was reclassified from Essential Practice to Additional Focus.
The use of negative pressure bandages was added as an Additional Practice. To date, available evidence suggests that this strategy is likely to be effective in specific procedures (e.g., abdominal procedures) and/or specific patients (e.g., increased body mass index).
The use of antiseptic-impregnated sutures was reclassified from Not Recommended to Additional Approaches.

Not recommended

Expanded discussion on the recommendation against routine use of vancomycin for antimicrobial prophylaxis.

Unresolved issues

The use of supplemental oxygen for patients requiring mechanical ventilation was reclassified from Essential Practice to Unresolved.
Added discussion on the use of antimicrobial powder.
Added discussion of the use of surgical attire as a strategy to prevent surgical site infection.

The guideline outlines other practices (surveillance to detect asymptomatic MRSA carriers and decolonization to eradicate or reduce the burden of MRSA among people colonized with MRSA) for specific patient populations.

“Basic infection prevention practices, such as hand hygiene and cleaning and disinfecting the environment and healthcare equipment, remain critical to preventing MRSA,” Calfee said. “These critical practices also help prevent the spread of other pathogens.”

The authors maintained contact precautions, the use of gowns and gloves when providing care to a patient with MRSA colonization or infection, as an essential practice. However, the authors recognize that, for a variety of reasons, some hospitals have chosen to modify or may be considering modifying the use of contact precautions for all or some patients who are colonized or infected with MRSA.

The updated recommendations provide guidance to help such hospitals assess risk, make informed decisions, monitor outcomes associated with changes in the use of contact precautions, and identify populations and settings in which continued use of contact precautions should be considered. contact.

MRSA infection is caused by a type of staph bacteria that is resistant to many of the antibiotics used to treat common staph infections. Healthcare-associated MRSA infections often follow invasive procedures, such as surgeries or the use of devices, such as central venous catheters, and can spread within hospitals through the hands of healthcare personnel or through contact with contaminated surfaces and equipment.

The guidance updates the 2014 Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals. The Compendium, first published in 2008, is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, with the Infectious Diseases Society of America, the Association of Professionals in Infection Control and Epidemiology, the American Hospital Association, and the Joint Commission, with significant contributions from representatives of several organizations and companies with content expertise. The Compendium is a highly collaborative, multi-year guideline writing effort of more than 100 experts from around the world.

In the coming weeks, a new section of the Compendium will be published outlining approaches to implementing infection prevention strategies, followed by an update on strategies to prevent catheter-associated urinary tract infections.

Recently published Compendium updates include strategies to prevent surgical site infections, central line-associated bloodstream infections, pneumonia and events related to ventilators and non-ventilators, C. difficile infection, and strategies to prevent care-associated infections medical care through hand hygiene.

Each Compendium article contains infection prevention strategies, performance measures, and approaches to implementation. The compendium’s recommendations are derived from a synthesis of systematic literature review, evidence evaluation, practical and implementation-based considerations, and expert consensus.

Combatting Resistant Infections in Hospitals: Strategies for Patient Safety

Escalating rates of MRSA infections during the pandemic highlight the importance of comprehensive infection control measures to safeguard patient health.