AWARENESS AND ADHERENCE TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) GUIDELINES, AS PER THE
WORLD HEALTH ORGANIZATION, AT ALEXANDRIA UNIVERSITY HOSPITALS
G.S.
1*
Soliman ,
R.M.
1*
Abu-Youssef ,
B.F.
1
Saleib ,
A.M.
1
El-Moughazi ,
A.
2
Zaki
1Alexandria
University, Faculty of Medicine; 2Alexandria University, Department of Bioinformatics and Medical Statistics, Medical Research Institute.
*Co-first authors.
Results
Clinicians must be aware of the potential danger of
MRSA infection. Countries that did not implement early
MRSA surveillance and control measures have struggled
to control MRSA epidemics.
Our Aim:
Assess the awareness and adherence to
MRSA control guideline recommendations among the
medical staff at Alexandria University Hospitals and
unveil the reasons, if any, for non-adherence.
experienced staff, who portrayed a level of
awareness of 60.5%, (p<0.01). Overall:
86% were aware that washing hands after
removing gloves is obligatory.
70% advocated screening high-risk patients to help
early detection.
However, 30% did not recognize the necessity of
using new gloves with each procedure performed on
the patient at hand, (p<0.05).
Methods
Pulmonology
I.C.U.
N.I.C.U./P.I.C.U.
A sample of 158 physicians and 47 nurses were
randomly selected from among medical staff working in
the departments of Anesthesiology, Cardiothoracic
Surgery, Coronary Care Unit (CCU), General Intensive
Care Unit (ICU), Neonatal ICU, Pediatric ICU, and
Pulmonology Medicine.
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
C.C.U.
Descriptive cross-sectional study conducted from
September to November 2010 at a local level,
examining the public healthcare staff at Alexandria
Main University Hospital & Pediatrics/Obstetrics
Hospital of Alexandria, Egypt.
 31.2% of the medical staff believed that the
Graph 2: AWARENESS OF
MRSA TRANSMISSION ACCORDING
TO YEARS OF EXPERIENCE
Graph 1: AWARENESS OF MRSA
GUIDELINE RECOMMENDATIONS
PER UNIT
Cardiothoracic
Surgery
60%
50%
40%
30%
20%
10%
0%
<=3 years
80%
33.3%
Written treatment algorithms/guideline copies in every unit
10
12.8%
Active surveillance by infection control supervisors for guideline
implementation; reward/punishment system to ensure strict adherence
14
17.9%
Improve availability of resources e.g. alcohol, isolation with individually
assigned doctor/nurse for infected patient
26
33.3%
2
2.6%
78
100.0%
Total
50%
40%
30%
Conclusions
20%
10%
0%
Unavailable
guideline copies on
department walls
Lack of
prioritization/work
overload
Work
overload
Lack of
awareness
Reasons for guideline non-implementation
(according to physicians/nurses)
Internet
UptoDate
Peers
Books
Journals
Medscape
Pharmaceutical Pamphlets
Tutors
Others
5%
10%
guideline
implementation
as
well
as
the
undertaking of periodic health education programs.
Lack of
resources
Clear
treatment
protocols
Screening
of high-risk
patients
of
Graph 6: COMMON GUIDELINE SOURCES FOR MEDICAL STAFF
0%
poor adherence to MRSA-related guidelines. Efforts
control team whose responsibility is the reinforcement
100%
80%
60%
40%
20%
0%
Physician/Nurse Response
Rate
The study showed low levels of awareness and
should be exerted to maintain an influential infection
Graph 5: MOST COMMON
REASONS FOR GUIDELINE NONIMPLEMENTATION
Graph 4: MOST COMMON NONIMPLEMENTED GUIDELINE
RECOMENDATIONS
Hand
washing
compliance
60%
50%
40%
30%
20%
10%
0%
Inadequate
implementation by
senior staff &
improper follow-up
Lack of
supervision
Lack of infection
control
program/team
Adequate
isolation
measures
MRSA is believed to be the result of decades of
antibiotic misuse. In a Mediterranean study
published in August 2007, the highest proportions of
MRSA were reported by Jordan, Egypt and Cyprus.
The prevalence of MRSA in Egypt was 52%, in
comparison to other Mediterranean countries such
as Lebanon, Morocco, Algeria, Tunisia and Malta,
which reported rates of 12, 19, 45, 18 and 50%,
respectively; while countries such as Jordan and
Cyprus reported higher rates of 56 and 55%,
respectively. In 2009, a local study performed at
Alexandria Main University Hospital reported that 71
out of 100 S. aureus isolates were MRSA.
26
70%
Results
Overall, the level of awareness of MRSA guidelines
was 67.3%. The highest rate of MRSA control
guideline awareness was found among medical staff
in the Neonatal ICU (85.7 %), while the lowest was
among Anesthesiology staff (45%), (p<0.05) (Graph 1).
55% identified the correct transmission routes
(p>0.05), (Graph 2), while 21% knew the most
important MRSA risk factor, namely open skin
wounds.
The number of years of experience partially affected
the level of awareness, as medical staff with more
than 3 years of experience were significantly more
aware of MRSA guideline recommendations (77.8%)
as compared to less
Infection control programs to teach staff; continuous medical education;
adding infection control as a curriculum subject for students/staff
Others e.g. administrative infrastructure changes
60%
Data was collected using a pre-tested self-administered
questionnaire covering detailed questions about the
magnitude of the problem of MRSA, awareness about
routes
of
transmission,
available
guideline
recommendations, and the rate of adherence to these
recommendations.
Physicians/Nurse
s
N
%
Graph 3: Reasons of lack of guideline awareness
Reasons of lack of guideline awareness
Introduction
>3 years
Correct MRSA transmission
routes
Most important MRSA risk factor
Percentage of awareness
guidelines are implemented.
 98.4% (p>0.05) of interviewees recognized the
importance of the role of guidelines, while 91.2%
(p<0.05) of them believed that they correctly follow
them.
 There was a large discrepancy in the ICU, where
100% believed in the importance of guidelines, while
only 89.2% believed that they implemented them, as
well as the Anesthesiology unit, where 87.5% believed
in their importance, while only 75% believed that they
adhere to them.
Table 1: SUGGESTIONS FROM PHYSICIANS/NURSES TO IMPROVE
MRSA CONTROL GUIDELINE AWARENESS & IMPLEMENTATION
Negligence
Problem Statement : MRSA is believed to be the result of decades of
antibiotic misuse. A study done at Alexandria Main University Hospital in
2009 reported that 71 out of 100 S. aureus isolates were MRSA. Clinicians
must be aware of the potential danger of MRSA infection.
Objectives : Assess the awareness and adherence to MRSA control guidelines
among the medical staff and unveil the reasons, if any, for non-adherence.
Design : Descriptive cross-sectional study.
Setting : Local level; examines the public sector healthcare staff at Alexandria
Main University Hospital & Pediatrics/Obstetrics Hospital.
Study population : The data collection was conducted from September 2010
to November 2010. A sample of 158 physicians and 47 nurses were randomly
selected from among medical staff working in the departments of
Anesthesiology, Cardiothoracic Surgery, Coronary Care Unit (CCU), General
Intensive Care Unit (ICU), Neonatal ICU, Pediatric ICU, and Pulmonology
Medicine. Data was collected using a pre-tested self-administered
questionnaire covering detailed questions about the magnitude of the
problem of MRSA, awareness about the routes of transmission, available
guidelines, and the rate of adherence to the guideline recommendations.
Results : Overall awareness of MRSA control guidelines was 67.3%. The
highest rate of awareness of MRSA guidelines was found among medical staff
in the Neonatal ICU (85.7 %), while the lowest was among Anesthesiology
staff (45%), (p<0.05). Medical staff with more than 3 years of experience
were significantly more aware of MRSA guidelines as compared to less
experienced staff (p<0.01). The three main reasons for lack of awareness
were a lack of infection control teaching program (72%), unavailable
guidelines on department walls (49%), and work overload (34%). 55% knew
the correct MRSA transmission routes. 86% were aware that washing hands
after removing gloves is obligatory, while 70% supported screening of highrisk patients to help early detection. 70% acknowledged the use of new
gloves with each procedure done on the patient. Regarding guideline
implementation, 31.2% of the medical staff believed that the guidelines are
implemented. Non-adherence to recommendations was mostly stated with
regards to isolation measures (56%), hand-washing compliance (35%), and
screening of high-risk patients (33.3%). The three main reasons for poor
adherence to guideline recommendations were unavailability of resources
(58%), lack of awareness (33%), and negligence (20%). 98% (p>0.05) of
interviewees agreed on the importance of the guidelines, while 91% (p<0.05)
believed that they adhere to them.
Conclusions : The study showed low levels of awareness and poor adherence
to MRSA-related guidelines. Efforts should be exerted to maintain an
influential infection control team whose responsibility is the reinforcement
of guideline implementation as well as the undertaking of periodic health
education programs.
Funding : Self-funded.
Objectives
Anesthesiology
Abstract
15%
20%
25%
Recommendations
 Posters to be available on department walls,
informing about MRSA, its routes of transmission,
and the guideline recommendations that should be
followed when caring for a patient.
 Easy equipment accessibility of gloves, gowns, face
masks, hand disinfectant and hand-washing stations
to help prevent MRSA spread.
 Isolation measures and screening of high-risk
patients to be firmly executed.