Transcript Dias nummer 1

Report from the MRSA
Working Group
Background
20th SSAC in Odense
Presentation by Prof. Karl G. Kristinsson
documented an increasing incidence of
MRSA in the Nordic countries
SSAC MRSA Working Party formed
Goal
Keeping the level of methicillin resistance
in Staphylococcus aureus below 1% in the
Nordic Countries
Denmark:
 Dr. Hans Jørgen Kolmos, Odense University Hospital
 Dr. Robert Skov, SSI, Chair
Finland:
 Dr. Reijo Peltonen, Turku University Hospital
 Dr. Jaana Vuopio-Varkila, KTL
Iceland:
 Dr. Hjordis Hardardottir, Landspitali University Hospital
 Dr. Olafur Gudlaugsson, Landspitali University Hospital
Norway:
 Dr. Stig Harthug, Haukeland University Hospital, and Norsk Folkehelse
 Dr. Yngvar Tveten, Telelab
Sweden:
 Dr. Barbro Olsson-Liljequist, SMI
 Dr. Tinna Åhrén, Sahlgrenska University Hospital
Tasks 1
 Suggest simple ways on
 how national data on the epidemiology of
MRSA can be reported to the Working Party
 reporting of the information to different
stakeholders and the public domain
 Compare current guidelines and practices,
including registration practices, laboratory
methodology and infection control in the Nordic
countries and identify similarities and major
discrepancies.
Tasks 2
Suggest quantifiable (measurable) goals for the
preventive strategies against MRSA in the
Nordic countries.
Suggest measures to obtain these goals
Identify and prioritise areas where there are
important gaps of knowledge and suggest
studies in these areas
Report regularly to the SSAC board and at
SSAC meetings.
Focus areas
Epidemiology
Laboratory Methodology
Infection Control
Epidemiology
Currently the terms and definitions vary
between the Nordic countries.
 Reporting infections vs both infections and
carriers
 Definition of a new episode vs relapse
 Acquisition
• HA-MRSA
• CO-MRSA
• CA-MRSA
*
04
20
03
20
02
20
01
20
00
20
99
19
98
19
97
19
96
19
95
19
94
19
Denmark
500
400
300
200
100
0
Denmark - acquisition - 2003
Unknown
5%
Active screening
18%
Comunity onset
without risk
25%
Imported
10%
Community onset
with risk
17%
Hospital aquired
21%
Finland, 1.1.1995-31.7.2004
Number of cases (infections AND carriers)
900
800
700
600
582
500
389
400
495
300
267
200
106
100
0
100
184
231
59
27
62
72
61
83
111
36
77
77
102
1995
1996
1997
1998
1999
2000
2001
2002
Helsinki area
Rest of the country
Source: KTL, National Infectious Disease Register
2003
291
31-072004
Finland;
children and the elderly
Number of cases (infections AND carriers)
900
800
700
600
500
<14 years
>65 years
total
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 Aug
04
Source: KTL, National Infectious Disease Register
Iceland
50
No. of Individuals
45
40
Health Care Ass.
35
Community Acq.
30
25
20
15
10
5
0
2002
2003
Year
2004 (-> Sept. 1st)
MRSA in Norway
By Acquisition
(January Through Aug 10th 2004)
No
160
140
Hosp. Acq.
120
Community-acq.
100
Unknown
80
60
40
20
0
1995
1996
1997
1998
1999
2000
Year
2001
2002
2003
2004est
Sweden
700
No. of Isolates
600
500
400
300
200
100
0
2000
2001
2002
2003
2004est
Sweden
Acquisition i 2004
24%
Domestic
Abroad
53%
23%
Unknown
Epidemiology
Suggestions for the future
 Development of uniform terms and definitions
 Initiate a coordinated Nordic surveillance
project
Laboratory methods
All countries but Norway have one central
laboratory for MRSA surveillance
 Norway is expected to have one quite soon
Collaboration on optimizing detection of
MRSA
Collaboration on uniform strain
nomenclature
Infection Control
It is possible to care for MRSA positive
patients without spread of MRSA.
For the successful control of MRSA it is
imperative that the MRSA positive
patient have the same rights for and
access to medical care as the MRSA
negative patient.
Infection Control
It has been observed that the increase is
slower in areas which practice very strict
MRSA policy
 For control of MRSA in hospitals it is
imperative to convince medical staff and
administrators that hygiene precautions must
be incorporated into daily routines
Infection Control
In order to enhance compliance and
decrease the risk for confusion, identical
measures should be applied within all
institutions within the same area/region.
These measures should be in accordance
with national guidelines and regulations.
Infection Control
Suggestions for the future
 Perform a Nordic multicenter study in
community onset MRSA
Conclusion 1
 The information collected and shared in
the Working Party has been of great
importance for use in the debate and
decision making in the individual
countries.
Conclusion 2
What is needed now
 Development of uniform epidemiological
terms and definitions
• Priority 1
 Increased knowledge on CA-MRSA
 Establish rapid exchange of information of
epidemics and endemicity between the Nordic
countries.