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MRSA in africa

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Infection control and MRSA. Comparison of European strategies and possible solutions for Africa

Infection control and MRSA. Comparison of European strategies and possible solutions for Africa

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  • 1. MRSA  in  Africa   November  2012   Andreas  Voss   iPrevent   UMCN  &  CWZ   Nijmegen,  The  Netherlands   ¤ One  of  the  first  cases  reported  in  the  conSnent   was  in  S.  Africa  in  1978.     ¤ In  Sudan,  MRSA  was  first  reported  in  1999   ¤ Madagascar  did  not  report  cases  of  MRSA  unSl   the  21st  century   ¤ The  prevalence  in  Africa  ranged  from  5%  to  45%.   hFp://data.worldbank.org  (access  on  7-­‐11-­‐2012)   Thesis  by  Nirma  D.  Bustamante                                            (2011)   South  Afr  J  Epidemiol  Infect  2011;26(4)(Part  II):243-­‐250  Anderas  Voss,  MD,  PhD   1  
  • 2. MRSA  in  Africa   November  2012   South  Afr  J  Epidemiol  Infect  2011;26(4)(Part  II):243-­‐250   Breurec  et  al.  CMI  2011;17:160-­‐65   HA-­‐MRSA    (Belgium,  Portugal,  SWE)                                                                          (28%)   HA-­‐  &  CA-­‐MRSA)                                                                          (21%)   HA-­‐MRSA    (Brazilian/Hungarian  clone)                                                                        (40%)   Breurec  et  al.  CMI  2011;17:160-­‐65   ¤ E-­‐MRSA   ¤   The  Netherlands  as  an  example  of  how  low     ¤ HA-­‐MRSA            (HO-­‐CA-­‐MRSA,  HO-­‐LA-­‐MRSA)    prevalence  countries  can  do  it…   ¤ CA-­‐MRSA            (CO-­‐HA-­‐MRSA,  CO-­‐LA-­‐MRSA)     ¤ LA-­‐MRSA   ¤   “Search  &  destroy”  strategy       The  only  type  I  am  interested  in:   ¤ IDCWYCI-­‐JTMHTFI-­‐MRSA*   *  I  Don’t  Care  What  You  Call  It  –  Just  Tell  Me  How  To  Fix  It  –  MRSA  (ScoF  Weese)  Anderas  Voss,  MD,  PhD   2  
  • 3. MRSA  in  Africa   November  2012   ¤  IsolaSon  and  screening  of  risk-­‐paSents  on  admission   ¤ Search  &  Destroy  (Control)  strategy  to  avoid   ² at  all  Smes     introducSon  of  MRSA  into  health-­‐care  senngs   ² colonized  and  infected  paSents   and  reduce  the  chance  of  transmission:   ¤  DecolonizaSon  of  MRSA  carriers     ² NaSonal  MRSA  guidelines  (www.WIP.nl)   ¤  Consequent  acSons  when  transmissions  occur   ² NaSonal  detecSon  methods  (NVMM)   ² screening  of  all  paSents  and  HCWs  at  risk   ² Use  fast  and  reliable  detecSon  methods   ² MRSA-­‐posiSve  HCWs  not  allowed  to  work       ¤  IsolaSon  and  screening  of  risk-­‐paSents  on  admission   ¤ Placement  in  isolaSon  room   ² can’t  determine  paSents  at  risk   ² with  anteroom  and  negaSve  pressure   ² only  certain  departments!   ² not  when  too  busy/weekends   ¤ Gloves,  gowns  and  face-­‐masks     ² only  infected  paSents   ² for  all  entering  the  room   ¤  No  decolonizaSon  of  MRSA  carriers   ¤  Consequent  acSons  when  transmissions  occur   ¤ Handhygiene   ² screening  of  all  paSents  but  not  HCWs    à  consequently   ¤ AnSmcrobial  stewardship   MRSA-­‐posiSve  HCWs  may  conSnue  to  spread        Anderas  Voss,  MD,  PhD   3  
  • 4. MRSA  in  Africa   November  2012   80 1999 2000 MRSA  BSI     70 2001 2002 episodes   2003 60 2004 2000 2005 2006 1800 50 Year and quarter 2007 1600 * % MRSA * 1400 40 1200 30 1000 800 * 20 * 600 400 10 * 200 0 0 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 NL (1401) LV (138) CZ (1289) LU (81) IL (458) IS (57) NO (522) SE (1770) DK (978) FI (679) SI (310) EE (123) AT (1002) PL (189) DE (991) HU (857) ES (1303) FR (2855) RO (79) UK (2803) HR (329) GR (541) CY (54) IE (1041) BG (137) BE (917) IT (1119) TR (827) MT (92) PT (836) 2005 2006 2007 2008 2009 1999 1999 1999 2000 1999 1999 2000 2004 2001 2000 2000 2000 2001 1999 1999 2001 1999 2000 2001 2002 2001 1999 2003 1999 2001 1999 1999 2003 1999 2000 Counts of MRSA bacteraemia Country code (average number of isolates reported per year) & year of start surveillance# Courtesy: A. Pearson (HPA, Sept 2009) EARSS report, October 2008 * DATA ARE PROVISIONAL NOT FOR WIDER CIRCULATION MRSA  bacteremia  in  Europe   Source: EARSS report ¤ IsolaSon  IntervenSons   ¤ PromoSon  of  Hand  Hygiene   ¤ IdenSficaSon  of  paSents  with  MRSA     infecSons  or  colonizaSons   ¤ Feedback   ¤ Annual  reports   V.  Jarlier  et  al.  Arch  Intern  Med  2010  Anderas  Voss,  MD,  PhD   4  
  • 5. MRSA  in  Africa   November  2012   IsolaSon  IntervenSons     ¤  Placement  of  paSents  with  MRSA  infecSons  or   colonizaSons  in  single-­‐bed  rooms  whenever  possible   ¤  Barrier  precauSons  for  paSents  with  MRSA  infecSons   or  colonizaSons  such  as:     ² disposable  gloves  worn  before  and  discarded  arer  paSent   contact   ² disposable  aprons  worn  for  extensive  contacts  (eg,  bed   making)   ² small  equipment  (eg,  stethoscope)  dedicated  to  the   paSent.   Should  we  ask  universal  precauSons  ?   PromoSon  of  Hand  Hygiene   IdenSficaSon  of  MRSA  PaSents       ¤  Hand  washing  with  disinfectant  soap  arer  contact  with   ¤  Passive  surveillance  through  rouSne  clinical  specimens   paSents  with  MRSA  infecSons  or  colonizaSons  before   leaving  the  room     ¤  AcSve  surveillance  (screening)  by  culturing  nares  of   paSents  with  a  high  risk  of  MRSA  colonizaSon,  eg,  intensive   ¤  An  insStuSonal  campaign  for  promoSng  the  use  of  alcohol-­‐ care  unit  (ICU)  paSents  and  contacts  of  MRSA  paSents   based  hand-­‐rub  soluSons  in  place  of  hand  washing     ¤  Quick  noSficaSon  and  flagging  of  new  paSents  with  MRSA   ² launched  in  2001     infecSons  or  colonizaSons  by  laboratories  to  medical  teams     ² Training  materials  to  the  infecSon  control  teams  (slide  shows,   ¤  IdenSficaSon  of  MRSA  paSent  rooms  and  charts  (sScker)     200  000  brochures,  and  14  000  posters)   ² formal  leFers  by  the  general  director  asking  all  administrators,   ¤  Informing  units  to  which  paSents  with  MRSA  are   heads  of  departments,  and  chief  nurses  to  support  the   transferred.   campaign.   Feedback     ¤ To  a  certainly  level  it  may  be  the  major   ¤  Feedback  to  the  local  hospital  community  on  the  results  (MRSA   rates  and  progress  in  program  implementaSon).   components  that  count  not  the  details:     ² Screening   Annual  report   ² IsolaSon  (single  room  and  glove  and  gowns)   ¤  Each  hospital  reporSng  to  the  central  administraSon   ² Hand  hygiene   ² size  of  the  infecSon  control  team   ² CommunicaSon   ² implementaSon  of  the  program   ² organizaSon  of  audits  (eg,  on  hand  hygiene)   ² feed-­‐back     ² progress  of  the  iniSaSve  has  been  annually  presented  during  meeSngs   of  infecSon  control  teams  and  bacteriologists  from  all  AP-­‐HP  hospitals,    Anderas  Voss,  MD,  PhD   5  
  • 6. MRSA  in  Africa   November  2012   ²   PrevenSon:  verScal  versus  horizontal  approach   While  important  other  factors  count:   ¤ Compliance  with  basic  infecSon  control   measures   ¤ Infrastructure  of  the  hospital   HAI  prevenSon   ¤ HCW-­‐paSent  raSo   ¤ AnSbioSc  use     ¤ Emergence  of  CA-­‐MRSA   ¤ Farming  (!)  &  food  (?)   ¤   Hand  hygiene     ¤   Flagging   ¤   Gloves   ¤   Environ.  Cleaning   ¤   Gowns   ¤   Screening   ¤   Masks   ² PaSents   ²   HCWs   ¤   Caps   ¤   AnSbioSc     ¤   Single  room    Stewardship   ¤   CohorSng   ¤   New  strategies   ¤   Info/feedback   ² horizontal  vs.  verScal   Isola>o Single   Hands   Gloves   Gowns   Mask   Cap   Cohort   n  Room   room   MRSA   NL   +   +   +   +   +   +   (+/-­‐)   outbreak   MRSA   +   Africa     +/-­‐   +/-­‐   -­‐   -­‐   -­‐   +/-­‐   -­‐   Screen   Screen   AB-­‐ Dedicated   Dedicated   Info   New   HCW   Equipme.   Flags   pts   HCWs   steward   Feedb.   strat   MRSA   NL   +   +   +   -­‐   +   +   +   +   MRSA   +   Africa   +/-­‐   +   +   +   +   +   +    Anderas  Voss,  MD,  PhD   6  

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