How the Dutch beat MRSA

Summary of a presentation by Dr Margreet Vos to the: MRSA – Learning from the Best conference, London, January 05.

The  Netherlands has had major success in keeping MRSA out of its hospitals.

One of the leading places for developing effective strategies to achieve this is the Erasmus University Medical Centre in  Rotterdam .

In 2002, at a neighbouring hospital, there was a sudden increase in the cases of MRSA among patients and healthcare workers, rising from an average of 400 to 1,200 cases. One of the main causes was the introduction of a new strain of MRSA. But it was not recognised as MRSA and in 2002 it, and other strains, were detected elsewhere.

At the 1,200-bed  Erasmus Medical Centre University Hospital ,  there were about 20 positive cases of MRSA per year. In 2002 this rose to 70.

Now in 2004 there is no MRSA in the outbreak hospital and other incidents are quickly eradicated using search and destroy.

"This is proof that you can come from a high endemic level then to hardly any MRSA. Many cultures are now taken from patients and healthcare workers and you don't see any outbreaks," said Dr Vos.

Dr Vos said one of the main reasons for success was search and destroy which involves the early detection, early identification and early containment of infection and encompasses patients, healthcare workers and the healthcare environment.

The critical success factors in the  Netherlands   highlighted by Dr Vos were:

• A national policy on infection prevention and control benchmarked by the Healthcare Inspectorate.
  
  
• National laboratory guidelines on detection and the transportation of patients from abroad.
  
  
• Local infection control committees implement policy, infection control facilities such as isolation rooms and trained healthcare workers exist.
  
  
• All new healthcare workers are educated about healthcare-associated infections.
  
  
• Risk classification of patients and healthcare workers (Class A - proven, Class B -high risk, Class C - increased risk Class D - no risk)
  
  - Class A and B - strict isolation on admission, pending culture test results.
  - Staff that come into contact with those patients wear gloves, a gown, mask and cap.
  - Class C are screened and limited contact made until proven negative.
  - Class A staff are removed from the hospital immediately and stay at home until proven negative.
  - Class B are restricted in their movement at work until proven negative.
  
  
• In the event of an outbreak the ward closes and only reopens after all patients and healthcare workers are negative, the ward is disinfected and non-disinfected material, such as paper, is destroyed.

Dr Vos said: "Search and destroy is not evidence-based - it is a package of measures. I can't give you the evidence base. But these are measures that do work. Search and destroy lacks evidence but this is not an argument to stop successful strategies."