MRSA Admission Screening Program in Oncology Ward

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Authors (including presenting author) :
Hon H C (1), Dr. Lam Y T (1)
Affiliation :
(1) Department of Oncology, Princess Margaret Hospital
Introduction :
The prevalence of methicillin-resistant staphylococcus aureus (MRSA) has increased in both healthcare facilities and the community. Hospital acquired MRSA (HA-MRSA) infection is defined as MRSA infection that develops 48 hours after hospital admission in patients without any MRSA in the previous one year. HA-MRSA strains tends to be multidrug resistant and predispose patients to more adverse outcomes, resulting in increased hospital costs. Oncology patients are immunocompromised and are at risk of carrying MRSA and multidrug resistant organisms (MDRO). Long-term care facilities residency and long-term instrumentation are known risk factors for carriage of multi-drug resistant organisms. Active surveillance through targeted screening helps to identify asymptomatic colonizers, enhance environmental control and help to reduce MRSA transmissions and infections.
Objectives :
1. To offer MRSA screening to high risk cases on admission 2. To enforce infection control measures to prevent transmission of organisms.
Methodology :
The screening program started in 3Q 2018. 1. Upon patient admission to oncology wards, nasal swab screening will be performed to all cases with the following inclusion criteria: A. institutionalized patients. B. transfer-in cases. C. patients with indwelling tubes such as tracheostomy, urinary catheters, percutaneous nephrostomy, biliary drainage tubes and feeding tubes etc. Known MRSA cases will be excluded. 2. Empirical contact precaution will be offered to all cases under screening until proven negative. 3. Known MRSA and screening-detected MRSA cases will be cohorted inside the same cubicle. 4. For patient under contact precautions, their immediate surroundings will be cleansed daily using diluted "Actichlor Plus 2-in-1" 5. Daily bathing with 2% chlorhexidine gluconate skin cleanser will be used/ educated to patients to reduce MRSA colonization and infection.
Result & Outcome :
Since the introduction of the screening program, the rates of MRSA and MDRO hospital acquired infections (HAI) in both of our wards have decreased. The HAI rate of MRSA in female ward decreased from 1.76 per 1000 patient (2Q 2018) to 0 (4Q 2018). The HAI rate of MDRO decreased from 0.7 per 1000 patient bed days (2Q 2018) to 0.38 (4Q 2018). For male ward, the HAI rate of MRSA decreased from 1.84 (2Q 2018) to 0.3 (4Q 2018). The HAI rate of MDRO decreased from 0.61 (2Q 2018) to 0.6 (4Q 2018).

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