Methicillin Resistance, Staphylococcal Infection, Staphylococcus Aureus
Conditions
Keywords
methicillin resistant Staphylococcus aureus, MRSA, cross-infection, staphylococcal infection, infection control
Brief summary
The purpose of this study is to evaluate the efficacy of a novel PCR-based laboratory test for rapid detection of MRSA carriers to prevent transmission of MRSA in the Belgian acute care hospital setting.
Detailed description
Methicillin-resistant Staphylococcus aureus (MRSA) strains have become endemic pathogens in acute and chronic healthcare facilities in Belgium. MRSA infection is causing increased public concern as it carries a significant risk of morbidity, mortality and has been linked to substantial excess healthcare costs. Efficient control of MRSA transmission within healthcare facilities critically depends on screening for and isolation of MRSA carriers among admitted patients. Active surveillance cultures for MRSA are now part of clinical practice recommendations both in Europe and the USA. Indeed, studies have indicated that up to 70 % of the patient reservoir for MRSA among hospitalized patients can only be detected by active sampling of muco-cutaneous colonization sites. There is an urgent public health need for early and reliable detection of carriers of MRSA among patients admitted to healthcare facilities, to inform patient isolation and decontamination procedures, and thereby more effectively control cross-infection The general objectives of this intervention study to be conducted in two large Belgian hospitals are to measure the impact of rapid (\< 3 h) PCR detection of MRSA carriage upon patient admission on shortening the delay to implement contact isolation precautions for carriers and reducing nosocomial MRSA transmission to patients admitted in the same wards.
Interventions
OTHERRapid MRSA PCR test for screening carriers
In the rapid test intervention arm, all patients admitted to study wards will be sampled within 24 h after admission. To ensure comparison of like with like, sample taking will include: (1) a swab from the anterior nares for PCR testing according to the test manufacturer's instructions; (2) the swab of anterior nares, and swabs from throat, perineum and of any wounds, bladder catheter or intravenous catheter exit site will be processed by conventional testing.
Sponsors
Erasme University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients admitted for more than 48h to a ward in which evaluation in the previous baseline period met the following: * \> 80 % compliance with admission and discharge conventional culture screening, for the pooled admissions to all study wards; * \> 80 % compliance with additional MRSA contact isolation procedures, based on a sample of 50 patient care contact observations per hospital in all study wards; * pooled incidence of nosocomial MRSA acquisition ≥ 1.5 new cases /100 at risk admissions in the study wards.
Exclusion criteria
* Patients staying 48h or less in the study wards
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| To determine if a ≥ 50 % reduction of incidence of nosocomial MRSA acquisition can be observed after replacing culture by PCR for universal MRSA screening of patients upon admission to high incidence units in two acute care hospitals | 5-10 months |
Secondary
| Measure | Time frame |
|---|---|
| Median time required for starting isolation of MRSA carriers | 5-10 months |
| Number of patient-days of MRSA carrier stay in non-isolated conditions | 5-10 months |
| Median time required for detection of MRSA carriage after admission | 5-10 months |
| MRSA cross-transmission rate | 5-10 months |
| Sensitivity and specificity of PCR vs conventional MRSA screening by culture | 10 months |
| MRSA nosocomial infection rate | 5-10 months |
Countries
Belgium
Outcome results
None listed