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Acta veterinaria Scandinavica2012; 54(1); 14; doi: 10.1186/1751-0147-54-14

Infection prevention and control interventions in the first outbreak of methicillin-resistant Staphylococcus aureus infections in an equine hospital in Sweden.

Abstract: The first outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in horses in Sweden occurred in 2008 at the University Animal Hospital and highlighted the need for improved infection prevention and control. The present study describes interventions and infection prevention control in an equine hospital setting July 2008 - April 2010. Methods: This descriptive study of interventions is based on examination of policy documents, medical records, notes from meetings and cost estimates. MRSA cases were identified through clinical sampling and telephone enquiries about horses post-surgery. Prospective sampling in the hospital environment with culture for MRSA and genotyping of isolates by spa-typing and pulsed-field gel electrophoresis (PFGE) were performed. Results: Interventions focused on interruption of indirect contact spread of MRSA between horses via staff and equipment and included: Temporary suspension of elective surgery; and identification and isolation of MRSA-infected horses; collaboration was initiated between authorities in animal and human public health, human medicine infection control and the veterinary hospital; extensive cleaning and disinfection was performed; basic hygiene and cleaning policies, staff training, equipment modification and interior renovation were implemented over seven months.Ten (11%) of 92 surfaces sampled between July 2008 and April 2010 tested positive for MRSA spa-type 011, seven of which were from the first of nine sampling occasions. PFGE typing showed the isolates to be the outbreak strain (9 of 10) or a closely related strain. Two new cases of MRSA infection occurred 14 and 19 months later, but had no proven connections to the outbreak cases. Conclusions: Collaboration between relevant authorities and the veterinary hospital and formation of an infection control committee with an executive working group were required to move the intervention process forward. Support from hospital management and the dedication of staff were essential for the development and implementation of new, improved routines. Demonstration of the outbreak strain in the environment was useful for interventions such as improvement of cleaning routines and interior design, and increased compliance with basic hygienic precautions. The interventions led to a reduction in MRSA-positive samples and the outbreak was considered curbed as no new cases occurred for over a year.
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Publication Date: 2012-03-08 PubMed ID: 22401493PubMed Central: PMC3325856DOI: 10.1186/1751-0147-54-14Google Scholar: Lookup
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  • Non-U.S. Gov't

Summary

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This research article examines the steps taken to manage the first occurrence of methicillin-resistant Staphylococcus aureus (MRSA) infection among horses in a Swedish equine hospital, emphasizing the importance of efficient infection control and prevention strategies.

Objective of the Study

  • The main objective is to delineate the control interventions employed in an equine hospital setting during the first outbreak of MRSA infection in Sweden.
  • The respective period of the study spans July 2008 – April 2010.

Methodology

  • The study is descriptive and its conclusions are drawn from analysis of policy documents, medical records, meeting notes, and cost estimates.
  • Identification of MRSA cases was executed through clinical sampling and telephone inquiries tracking horses post-surgery.
  • The researchers carried out environmental sampling in the hospital and included culture for MRSA and genotyping of isolates via spa-typing and pulsed-field gel electrophoresis (PFGE).

Interventions Deployed

  • Temporary suspension of elective surgery.
  • Identification and isolation of MRSA-contaminated horses.
  • Collaboration between animal and human public health authorities, infection control in human medicine, and the veterinary hospital.
  • Implementation of comprehensive cleaning and disinfection.
  • Introduction of basic hygiene, cleaning policies, staff training, equipment modification, and interior renovation over seven months.

Results

  • Ten out of ninety-two surfaces sampled tested positive for MRSA spa-type 011.
  • PFGE typing revealed the outbreak strain in nine of the ten cases, or a closely related strain.
  • Two new MRSA cases arose, fourteen and nineteen months later respectively, without proven connections to the initial outbreak cases.

Conclusions

  • For successful intervention, strategic collaboration is required between relevant authorities, the veterinary hospital, and the formation of an infection control committee with an executive working group.
  • The commitment of hospital management and staff is crucial for developing and implementing new, improved procedures.
  • Identifying the outbreak strain in the environment helps in refining cleaning routines, modifying interior design, and promoting compliance with basic hygiene measures.
  • The effective interventions enabled the reduction of MRSA-positive samples, with no new cases reported for over a year, which suggested that the outbreak was adequately contained.

Cite This Article

APA
Bergström K, Nyman G, Widgren S, Johnston C, Grönlund-Andersson U, Ransjö U. (2012). Infection prevention and control interventions in the first outbreak of methicillin-resistant Staphylococcus aureus infections in an equine hospital in Sweden. Acta Vet Scand, 54(1), 14. https://doi.org/10.1186/1751-0147-54-14

Publication

Acta veterinaria Scandinavica
ISSN: 1751-0147
NlmUniqueID: 0370400
Country: England
Language: English
Volume: 54
Issue: 1
Pages: 14

Researcher Affiliations

Bergström, Karin
  • Department of Animal Environment and Health, Faculty of Veterinary Medicine and Animal Husbandry, Swedish University of Agricultural Sciences, Uppsala, Sweden. karin.bergstrom@sva.se
Nyman, Görel
    Widgren, Stefan
      Johnston, Christopher
        Grönlund-Andersson, Ulrika
          Ransjö, Ulrika

            MeSH Terms

            • Animals
            • Cross Infection / prevention & control
            • Cross Infection / veterinary
            • Genotype
            • Horse Diseases / microbiology
            • Horse Diseases / prevention & control
            • Horses
            • Hospitals, Animal / legislation & jurisprudence
            • Hospitals, Animal / standards
            • Infection Control / economics
            • Methicillin-Resistant Staphylococcus aureus / genetics
            • Methicillin-Resistant Staphylococcus aureus / isolation & purification
            • Staphylococcal Infections / microbiology
            • Staphylococcal Infections / prevention & control
            • Staphylococcal Infections / veterinary
            • Sweden

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