Changes in incidence of MRSA in three different phases of intervention.

<p>Note. Phase 1: baseline observation period; phase 2: launch of the first intervention - hand hygiene campaign; phase 3: continuation of phase 2 plus launch of the second intervention - contact precautions;</p>1<p>Insignificant change in trend in Phase 2 vs Phase 1 was found for all models, implying the same slope within Phases 1 and 2;</p>2<p>IRR denotes incidence rate ratio obtained from segmented Poisson regression, and CI denotes confidence intervals;</p>3<p>Percentage change in incidence rate obtained from (IRR−1)×100%; NS, not significant.</p

Incidence rate of hospital-acquired MRSA per 1000 patient-days in the three phases of intervention.

<p>Incidence rate of hospital-acquired MRSA per 1000 patient-days in the three phases of intervention.</p

Incidence rate of hospital-acquired MRSA per 1000 MRSA-positive-days in three different phases of intervention.

<p>Incidence rate of hospital-acquired MRSA per 1000 MRSA-positive-days in three different phases of intervention.</p

The epidemiological characteristics of MRSA in 3 different phases of intervention.

<p>Note. Phase 1: baseline observation period; phase 2: launch of the first intervention - hand hygiene campaign; phase 3: continuation of phase 2 plus launch of the second intervention - contact precautions.</p>a<p>wound specimens included deep wound, superficial wound, and ulcer swabs.</p>b<p>respiratory specimens included sputum, tracheal aspirates, bronchoalveolar lavage;</p>c<p>urine specimens included mid-stream urine, catheterized urine, suprapubic catheterization, nephrostomy drain urine;</p>d<p>sterile body fluid included pus.</p

Proactive infection control measures to prevent nosocomial transmission of vancomycin-resistant enterococci in Hong Kong

Background/Purpose: The study describes a proactive infection control approach to prevent nosocomial transmission of vancomycin-resistant enterococci (VRE) and tests if this approach is effective for controlling multiple-drug resistant organisms in a nonendemic setting. Methods: In response to the increasing prevalence of VRE in Hong Kong since 2011, we adopted a multifaceted assertive approach in our health care network. This included active surveillance culture, extensive contact tracing, directly observed hand hygiene in conscious patients before they received meals and medications, stringent hand hygiene and environmental cleanliness, and an immediate feedback antimicrobial stewardship program. We report the occurrence of VRE outbreaks in our hospital after institution of these measures and compared with the concurrent occurrence in other public hospitals in Hong Kong. Results: Between July 1, 2011 and November 13, 2013, VRE was identified in 0.32% (50/15,851) of admission episodes by active surveillance culture. The risk of VRE carriage was three times higher in patients with a history of hospitalization outside our hospital networks in the past 3 months (0.56% vs. 0.17%; p=0.001) compared with those who were not. Extensive contact tracing involving 3277 patient episodes was performed in the investigation for the 25 VRE index patients upon whom implementation of contact precautions was delayed (more than 48 hours of hospitalization). One episode of VRE outbreak was identified in our hospital network, compared with the 77 VRE outbreaks reported in the other hospital networks (controls) without these proactive infection control measures. Conclusion: Our multifaceted assertive proactive infection control approach can minimize the nosocomial transmission and outbreak of VRE in a nonendemic area. © 2014