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This cross-sectional study aimed to assess knowledge of routes of transmission, awareness of MRSA control guidelines and reasons for non-adherence to guidelines among medical staff at Alexandria University hospitals. A random sample of 158 physicians and 47 nurses answered a self-administered questionnaire. Overall awareness of MRSA control guidelines was 67.3%, and nurses were significantly more aware than physicians (91.5% versus 60.1%). The lowest awareness level was among anaesthesiologists; only 54.4% knew the correct transmission routes. Among medical staff overall, 70.0% accepted the necessity of screening measures for high-risk patients and 35.8% of doctors accepted the use of the same pair of gloves when caring for different body sites on an individual patient. Lack of resources was the most common justification for suboptimum adherence. The study showed low awareness levels of MRSA-related guidelines.
الوعي بالدلائل الإرشادية لمنظمة الصحة العالمية حول العنقوديات الذهبية المقاومة للميثيسيلين في مستشفيات جامعة الإسكندرية
جيرمين سامح سليمان، راندة محمود أبو يوسف، بيشوي فهمي صليب، أحمد محمد المغازي، عادل زكي
تهدف دراستنا المستعرضة هذه إلى تقييم معارف العاملين الطبيين في مستشفيات جامعة الإسكندرية حول طرق السراية، والمعرفة بالدلائل الإرشادية لمكافحة العنقوديات الذهبية المقاومة للميثيسيلين، وأسباب عدم الامتثال لتلك الدلائل الإرشادية. وقد شملت العينة العشوائية 158 طبيباً و 47 ممرضة أجابوا على استبيان يدار ذاتياً، وتبيَّ للباحثين أن الوعي الإجمالي بالدلائل الإرشادية لمكافحة العنقوديات الذهبية المقاومة للميثيسيلين يبلغ 67.3%، وأن الممرضات أكثر وعياً (91.5%) من الأطباء (60.1%)، وكان أخفض مستوى للوعي بين أطباء التخدير، إذ لم يعرف سوى 54.4% منهم طرق السراية الصحيحة. وقد تقبَّل 70% من مجمل العاملين الطبيين ضرورة اتخاذ تدابير التحري لدى المرضى المعرضين لاختطار مرتفع، كما تقبَّل 35.8% من الأطباء استخدام القفازات ذاتها عند رعاية مواضع مختلفة من الجسم لدى نفس المريض. واتضح أيضاً أن نقص الموارد هو التبرير الأكثر شيوعاً لعدم بلوغ الحد القريب من الأمثل في الامتثال. وتظهر الدراسة انخفاض مستوى الوعي بالدلائل الإرشادية حول مكافحة العنقوديات الذهبية المقاومة للميثيسيلين.
Sensibilisation aux recommandations de l\'Organisation mondiale de la Santé sur la lutte contre Staphylococcus aureus résistant à la méthicilline dans des hôpitaux universitaires d\'Alexandrie.
La présente étude transversale visait à évaluer la connaissance des voies de transmission, la sensibilisation aux recommandations sur la lutte contre Staphylococcus aureus résistant à la méthicilline et les motifs du non respect de ces recommandations par le personnel médical des hôpitaux universitaires d\'Alexandrie. Un échantillon randomisé de 158 médecins et 47 infirmières ont répondu à un auto-questionnaire. Globalement, la sensibilisation aux recommandations sur la lutte contre Staphylococcus aureus résistant à la méthicilline était de 67,3 %, et le personnel infirmier était beaucoup plus sensibilisé que les médecins (91,5 % contre 60,1 %). Le niveau de sensibilisation le plus faible a été retrouvé chez les anesthésistes. Seuls 54,4 % de ces derniers connaissaient les voies de transmission correctes. Au sein du personnel médical globalement, 70,0 % avaient accepté la nécessité de mesures de dépistage pour les patients à haut risque mais 35,8 % des médecins reconnaissaient utiliser une seule paire de gants même lors de soins prodigués sur différents sites corporels d\'un même patient. Le manque de ressources était la justification la plus fréquente pour le respect insuffisant de ces recommandations. L\'étude a mis en évidence les faibles niveaux de sensibilisation aux recommandations sur la lutte contre Staphylococcus aureus résistant à la méthicilline.

BACKGROUND: The compliance of hospital staff with guidelines for the active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in Israel has not been determined.
OBJECTIVE: To evaluate the compliance of hospital staff with guidelines for the active surveillance of MRSA and assess its impact on the incidence of nosocomial MRSA bacteremia.
METHODS: We assessed compliance with MRSA surveillance guidelines by assessing adherence to the screening protocol and reviewing medical and nursing charts of patients colonized with MRSA, and observed hand hygiene opportunities among health care workers and colonized patients. Rates of nosocomial MRSA bacteremia and of adherence with hand hygiene among overall hospital staff were obtained from archived data for the period 2001-2010.
RESULTS: Only 32.4% of eligible patients were screened for MRSA carriage on admission, and 69.9% of MRSA carriers did not receive any eradication treatment. The mean rate of adherence to glove use among nurses and doctors was 69% and 31% respectively (P<0.01) and to hand hygiene 59% and 41% respectively (P<0.01). The hospital overall rate of adherence to hand hygiene increased from 42.3% in 2005 to 68.1% in 2010. Rates of nosocomial MRSA bacteremia decreased by 79.2%, from 0.48 (in 2001) to 0.1 (in 2010) per 1000 admissions (P<0.001).
CONCLUSIONS: The compliance of medical and nursing staff with guidelines for active MRSA surveillance was poor. The encouraging increase in adherence to hand hygiene and concomitant decrease in nosocomial MRSA bacteremia is gratifying. The deficiencies in compliance with MRSA infection control policy warrant an adjusted strategy based on the hospital resources.

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Bacteremia and endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) are prevalent and clinically important. The rise in MRSA bacteremia and endocarditis is related with the increasing use of venous catheters and other vascular procedures. Glycopeptides have been the reference drugs for treating these infections. Unfortunately their activity is not completely satisfactory, particularly against MRSA strains with MICs > 1 microg/mL. The development of new antibiotics, such as linezolid and daptomycin, and the promise of future compounds (dalvabancin, ceftobiprole and telavancin) may change the expectatives in this field.The principal aim of this consensus document was to formulate several recommendations to improve the outcome of MRSA bacteremia and endocarditis, based on the latest reported scientific evidence. This document specifically analyzes the approach for three clinical situations: venous catheter-related bacteremia, persistent bacteremia, and infective endocarditis due to MRSA.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen throughout the world, and in Croatia as well. Therefore it was decided to develop guidelines with the aim to reduce the number of patients infected/colonized with MRSA in healthcare facilities and in nursing homes in Croatia, consequently reducing MRSA-related morbidity and mortality. An interdisciplinary team of experts developed these guidelines using existing international guidelines from different countries, and literature reviews about prevention, control, treatment and laboratory diagnosis of MRSA infections. Grades of evidence for specific recommendations were determined using CDC/HICPAC grading system. Categorization is based on existing data, theoretical basis, applicability and economic impact. After a broad discussion in different professional societies, Guidelines were accepted. Guidelines include recommendations for measures in prevention of MRSA spread, role of hospital management, rational use of antibiotics, measures in a case of outbreak, treatment of infections and brief review of community-acquired MRSA. At the end, appendices concerning hospital audit, algorithms of laboratory diagnosis, patient information and form for national MRSA surveillance were added.

We report a case of community acquired methicillin resistant Staphylococcus aureus pneumonia. The causative organism was positive for the toxin Panton-Valentine Leukocidin. This resulted in a severe pneumonia requiring a prolonged stay on our intensive care unit. This infection is becoming more common in the United Kingdom. It can cause a far more aggressive illness than the hospital acquired infection with a high mortality if it becomes an invasive infection. The Department of Health has recently produced interim guidelines for its treatment which we have also reviewed.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen, both in-hospital and in the community. Although there are several guidelines with recommendations for the control of this microorganism, the measures proposed are not uniformly implemented in Spanish hospitals. The objective of this document is to provide evidence-based recommendations that are applicable to Spanish hospitals, with the aim of reducing transmission of MRSA in our health care centers. The recommendations are divided into the following groups: surveillance, active detection of colonization in patients and health care workers, control measures for colonized or infected patients, decolonization therapy, environmental cleaning and disinfection, antimicrobial consumption, measures for non-hospitalized patients, and others. The main measures recommended include appropriate surveillance, hand hygiene, and implementation of active surveillance, contact precautions, and environmental cleaning.