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In what settings do MRSA skin infections occur?
• MRSA skin infections can occur anywhere.
• Some settings have factors that make it easier for MRSA to be transmitted.
• These factors, referred to as the 5 Cs, are as follows: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness.
Increasing numbers of hospital-acquired infections have generated much attention over the last decade. The public has linked the so-called 'superbugs' with their experience of dirty hospitals but the precise role of environmental cleaning in the control of these organisms remains unknown. Until cleaning becomes an evidence-based science, with established methods for assessment, the importance of a clean environment is likely to remain speculative. This review will examine the links between the hospital environment and various pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, norovirus, Clostridium difficile and acinetobacter. These organisms may be able to survive in healthcare environments but there is evidence to support their vulnerability to the cleaning process. Removal with, or without, disinfectants, appears to be associated with reduced infection rates for patients. Unfortunately, cleaning is often delivered as part of an overall infection control package in response to an outbreak and the importance of cleaning as a single intervention remains controversial. Recent work has shown that hand-touch sites are habitually contaminated by hospital pathogens, which are then delivered to patients on hands. It is possible that prioritizing the cleaning of these sites might offer a useful adjunct to the current preoccupation with hand hygiene, since hand-touch sites comprise the less well-studied side of the hand-touch site equation. In addition, using proposed standards for hospital hygiene could provide further evidence that cleaning is a cost-effective intervention for controlling hospital-acquired infection.
Department of Microbiology, Hairmyres Hospital, East Kilbride, UK
Journal of Hospital Infection
Volume 73, Issue 4, December 2009, Pages 378-385
Proceedings of The Lancet Conference on Healthcare-Associated Infections
Copyright © 2009 The Hospital Infection Society Published by Elsevier Ltd.
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Formerly a consultant microbiologist at the Southern General Hospital in Glasgow, Scotland (2005-7), Stephanie now works in NHS Lanarkshire and is the current editor of the Journal of Hospital Infection. She trained at St. Bartholomew's hospital in London (1977-83) followed by postgraduate studies in Pathology at Guy's hospital, where she produced a thesis on the epidemiology and biochemistry of toxin-producing staphylococci. She has worked in various remote areas of the world, including Papua New Guinea, Thailand, Vietnam and the Canadian High Arctic, where she resuscitated 30,000 year old organisms from glacial ice. She spent six years as the Infection Control Officer for Argyll before moving to Health Protection Scotland as their inaugural microbiologist (2002-5). There she set up MRSA surveillance for Scotland, evaluated real-time PCR for the rapid identification of MRSA and helped establish the Scottish Microbiology Forum. She has been an active member of several national working groups on antibiotic prescribing and hospital cleaning, and was a formal referee for the Scottish Health Technology Assessment on MRSA screening. At present she balances clinical and editorial duties with various research projects, specifically the role of antibiotics, screening and cleaning in the control of MRSA.
Dr. Stephanie J. Dancer
Department of Microbiology
Eaglesham Road, East Kilbride G75 8RG, UK.
Tel +44 (0)1355 585000