Incidence, prevalence, and management of MRSA bacteremia across patient populations

A review of recent developments in MRSA management and treatment | Critical Care

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Image source: Annie Cavanagh – Wellcome Images // CC BY-NC 4.0

Image shows clusters of methicillin-resistant Staphylococcus aureus bacteria.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is still a major global healthcare problem. Of concern is S. aureus bacteremia, which exhibits high rates of morbidity and mortality and can cause metastatic or complicated infections such as infective endocarditis or sepsis. MRSA is responsible for most global S. aureus bacteremia cases, and compared with methicillin-sensitive S. aureus, MRSA infection is associated with poorer clinical outcomes. S. aureus virulence is affected by the unique combination of toxin and immune-modulatory gene products, which may differ by geographic location and healthcare- or community-associated acquisition.

Management of S. aureus bacteremia involves timely identification of the infecting strain and source of infection, proper choice of antibiotic treatment, and robust prevention strategies. Resistance and nonsusceptibility to first-line antimicrobials combined with a lack of equally effective alternatives complicates MRSA bacteremia treatment.

This review describes trends in epidemiology and factors that influence the incidence of MRSA bacteremia. Current and developing diagnostic tools, treatments, and prevention strategies are also discussed.

Full reference: Hassoun, A. et al. (2017) Incidence, prevalence, and management of MRSA bacteremia across patient populations—a review of recent developments in MRSA management and treatment. Critical Care. 21:211

Reducing catheter-associated urinary tract infections in the ICU

This review provides a summary of CAUTI reduction strategies that are specific to the intensive care setting | Current Opinion in Critical Care

Purpose of review: Patients in the ICU are at higher risk for catheter-associated urinary tract infection (CAUTI) due to more frequent use of catheters and lower threshold for obtaining urine cultures.

Recent findings: The surveillance definition for CAUTI is imprecise and measures catheter-associated bacteriuria rather than true infection. Alternatives have been proposed, but CAUTI rates measured by this definition are currently required to be reported to the Centers for Medicare and Medicaid Services and high CAUTI rates can result in financial penalties. Although CAUTI may not directly result in significant patient harm, it has several indirect patient safety implications and CAUTI reduction has several benefits. Various bundles have been successful at reducing CAUTI both in individual institutions and on larger scales such as healthcare networks and entire states.

Summary: CAUTI reduction is possible in the ICU through a combination of reduced catheter usage, improved catheter care and stewardship of urine cultures.

Full reference: Sampathkumar, P. (2017) Reducing catheter-associated urinary tract infections in the ICU. Current Opinion in Critical Care: Published online: 28 July 2017

No-touch methods of terminal cleaning in the intensive care unit

Results from the first large randomized trial with patient-centred outcomes | Critical Care

Environmental contamination may play a major role in intensive care unit (ICU)-acquired infections, despite current terminal cleaning standards. Anderson et al. recently performed the first large randomized trial investigating a no-touch method of terminal cleaning with a patient-centred outcome, and provided more robust data on the role of environmental contamination for healthcare-associated infections. The authors evaluated three different enhanced terminal disinfection methods (ultraviolet, UV light, UV light plus bleach, and bleach) compared to the reference standard for prevention of transmission of multidrug resistant organisms (MDROs) and Clostridium difficile to patients exposed to a room whose prior occupant was either colonized or infected with a MDRO.

Full reference: Russotto, V. et al. (2017) No-touch methods of terminal cleaning in the intensive care unit: results from the first large randomized trial with patient-centred outcomes. Critical Care. 21:117.

Prevention of central venous line associated bloodstream infections in adult intensive care units

Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters | Intensive and Critical Care Nursing

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Aim: Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters.

Methods: A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion.

Results: Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the ‘On the CUSP: Stop Blood Stream Infections’ national programme.

Conclusions: Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.

Full reference: Velasquez Reyes, D.C. et al. (2017) Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive and Critical Care Nursing. Published online: 26 June 2017

Removal of sinks and introduction of ‘water-free’ patient care

Sinks in patient rooms are associated with hospital-acquired infections | Antimicrobial Resistance & Infection Control

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Background: The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’ patient care on gram-negative bacilli colonization rates.

Conclusions: Removal of sinks from patient rooms and introduction of a method of ‘water-free’ patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay.

Full reference: Hopman, J. et al. (2017) Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care. Antimicrobial Resistance & Infection Control. 6:59

Monitoring the hand hygiene compliance of health care workers

Brotfein, E. et al. American Journal of Infection Control | Published online: 4 May 2017

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Highlights:

  • CCTV is a new and reliable method for observation of hand hygiene.
  • CCTV methodology records a different performing hand hygiene compared to overt observation.
  • Covert observations using CCTV can replace direct overt observation for hand hygiene of HCWs.

Read the full abstract here

The value of direct observation to reduce catheter-associated urinary tract infection

Afonso, E. & Blot, S. Intensive and Critical Care Nursing | Published online: 26 April 2017

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Urinary tract catheterization and monitoring of the urinary output is indispensable in critically ill patients as might indicate intravascular circulating volume, organ perfusion, and pending shock (Paratz et al., 2014; Eastwood et al., 2015). The presence of a urinary catheter however involves the risk of infection.

We read with interest the article by Galiczewski and Shurpin (2017) about the efficiency of direct observation to reduce bladder catheter utilization and catheter-associated urinary tract infections in the ICU.

Read the comment article here

Read the original research article here