Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
J Hosp Infect. 2011 Jun;78(2):97-101. doi: 10.1016/j.jhin.2011.02.010. Epub 2011 Apr 6.
Healthcare-associated infection by meticillin-resistant Staphylococcus aureus (MRSA) is still a great concern in an intensive care unit (ICU). Our surveillance data in the ICU revealed that intubated patients were at eight times higher risk of acquiring MRSA than non-intubated patients, so we hypothesised that pre-emptive contact precautions for all intubated patients would prevent healthcare-associated infection by MRSA in the ICU. Patients staying in our ICU for >2 days were included in this study. The study period was divided into two periods. During 2004 (1st period), contact precautions were performed only for patients with MRSA. During 2005-2007 (2nd period), contact precautions were applied to all intubated patients regardless of MRSA infection status. Patients were defined as MRSA-positive on admission when MRSA was detected by surveillance or clinical culture on enrolment. Other MRSA-positive results were defined as healthcare-associated MRSA (HA-MRSA) transmission. HA-MRSA infection was diagnosed according to the National Nosocomial Infections Surveillance Manual. The 1st period comprised 415 patients, and the 2nd period comprised 1280 patients. In intubated patients, HA-MRSA infection rate decreased significantly in the 2nd period (1st period 12.2%, 2nd period 5.6%; P=0.015). HA-MRSA infection of all patients decreased from 3.6 to 2.3 incidents per 1000 patient-days (P<0.05), despite a significant increase in the rate of patients MRSA positive on admission in the 2nd period (1st period 2.9%; 2nd period 6.1%). Pre-emptive contact precautions for intubated patients would be helpful in reducing HA-MRSA infection in ICU.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的医源性感染仍然是重症监护病房（ICU）的一大关注点。我们的 ICU 监测数据显示，插管患者感染 MRSA 的风险是未插管患者的 8 倍，因此我们假设对所有插管患者采取先发制人的接触预防措施，将预防 ICU 中 MRSA 引起的医源性感染。本研究纳入在 ICU 住院时间>2 天的患者。研究期间分为两个阶段。2004 年（第一阶段）期间，仅对 MRSA 患者采取接触预防措施。2005-2007 年（第二阶段）期间，无论 MRSA 感染状态如何，均对所有插管患者采取接触预防措施。入院时通过监测或临床培养发现 MRSA 时，患者即被定义为 MRSA 阳性。其他 MRSA 阳性结果定义为医源性耐甲氧西林金黄色葡萄球菌（HA-MRSA）传播。根据《国家医院感染监测手册》诊断 HA-MRSA 感染。第一阶段包括 415 例患者，第二阶段包括 1280 例患者。在插管患者中，第二阶段 HA-MRSA 感染率显著下降（第一阶段 12.2%，第二阶段 5.6%；P=0.015）。尽管第二阶段入院时 MRSA 阳性患者的比例显著增加（第一阶段 2.9%，第二阶段 6.1%），但所有患者的 HA-MRSA 感染率从每 1000 个患者日 3.6 例降至 2.3 例（P<0.05）。对插管患者采取先发制人的接触预防措施有助于减少 ICU 中 HA-MRSA 感染。
