MRSA Prevention and Control Program in King Fahad Medical City

Background:
Active surveillance cultures (ASC) facilitate identification of patients with MRSA colonization to be placed on contact precautions with the goal of minimizing MRSA spread to other patients. Because patients with evidence of MRSA in routine clinical specimens represent only a small fraction of the reservoir for spread of antibiotic-resistant pathogens, active surveillance specimens identify the reservoir of asymptomatic, colonized patients who would otherwise go unrecognized and unisolated.
Objective:
To decrease the rate and severity of MRSA Hospital associated infections (HAI) in our hospital through implementing cost effective prevention program.
Methods:
MRSA Improvement Program has been introduced in our hospital since 1st January 2008 in the form of MRSA Bundle with two components:
1. Pre-emptive screening of at risk patients that is done in emergency departments (adult and pediatric) by using of active surveillance rapid PCR test for nasal swab, which detect the presence of MRSA within 4 hours. Screening indications:
·          Patients transferred from other hospitals
·          Patients with history of hospitalization less than a month before admission
·          Patients with history of infection or colonization with MRSA
MRSA positive patients will be isolated in a single room or cohorted only with other similer MRSA patients.
MRSA negative patients will be admitted to shared room.
  2. Maximum contact precautions are applied in patients with positive PCR test, who have been admitted in single room or cohorted with other MRSA patients and consists of: hand washing (before entry patient room, before exit the patient room, after exit the patient room),wearing gloves, gown, and face mask.
Results:
The rate of MRSA HAI decreased from 24 infections (0.17 /1000 patient-days) in 2oo7 to 14 infections (0.03 /1000 patient- days) in 2009. MRSA procedure related infection rate decreased from 0.1% in2007 to 0.02% in 2009. Number of MRSA associated Blood stream infections decreased from 4 in 2008 to 0 in 2009.
Conclusions:
MRSA prevention bundle in KFMC which depend on rapid screening, isolation and maximum contact precautions has been successfully implemented and resulted in significant reduction in the rate of MRSA HAI and in severity of disease.