Table 1 Course of the MRSA outbreak and interventions in an equine hospital, 2008-2010
Time | Course and Intervention |
|---|---|
2008 | |
Jan | Jan 1, Methicilin-resistant coagulase-positive staphylococci notifiable in animals in Sweden . |
June | 12 June, MRSA Case 1 diagnosed. Surgery on May 22. |
July, main outbreak month | 4 July, Case 2 diagnosed (surgery on 2 Jun). Outbreak suspected. Five of six horses infected had undergone surgery at this time. Elective surgery suspended and Stable A closed. First telephone meeting with human and veterinary authorities. |
16 July, Meeting 1- at the UDS with community vet, public health nurse + SVA. | |
Tracing- 45 horses had surgery during outbreak, 37 answers, four suspects, one MRSA-positive. | |
18-30 July , Case 3, 4 and 5 diagnosed, sampled at home as clinical infection. Case 5 traced by phone. | |
22 July , first environmental sampling, 7 of 18 positive (7/18) (Table 2). Door knobs disinfected. | |
Consultation visit , human infection control (IC). IC committee + executive working group formed. | |
Disinfectant dispensers installed at all sinks and doors. | |
Replacement of water feeders with buckets started. | |
Aug | 16 Aug, Case 6 diagnosed, emergency surgery on 7 July, stayed isolated in UDS until mid-Dec. |
Meeting 2- IC consultation, county vet, heads of UDS, further discussions + planning. | |
Meeting 3- with staff concerning sampling of personnel and education of basic hygiene. | |
Cleaning of surgery unit- theatres cleaned by professional hospital cleaners. | |
Cleaning routines- critical points tenside + isopropylalcohol disinfection, cleaning detergent only. | |
Implementation- e.g. surgery routine, no brush of skin, soap + alcohol-based hand disinfect. | |
Equipment test- endoscope (culture working canal), arthroscope, disinfector, autoclave. | |
Elective surgery restarted. | |
Sep - Nov | Basic hygiene policy + personal appearance, for staff to read and sign. |
Lecture- to staff about MRSA, hygiene, infection control and the implementation process. | |
Voluntary MRSA sampling of staff, 12/30 sampled, all neg. | |
Cleaning- elimination of loose equipment and cleaning of stables. | |
Replacing- most water feeders + cribs replaced by buckets. Salt stones + holders abolished. | |
Second environmental sampling- 1/14, on pooled sample from 21 door knobs pos (Table 2). | |
Dec | Third environmental sampling - retest of door knobs divided into seven samples, 0/7 (Table 2). |
Written routines- surgery unit including hygiene, cleaning, instrument washing + disinfection and preparing horses for surgery. | |
Written report from IC consultant, what had been achieved and what remained to be done. | |
2009 | |
Jan - Feb | Renovation- recovery rooms new floor/walls, flusher disinfector installed. |
Written routines for cleaning and disinfection of stables, day patient area + ISO. | |
Written routines disinfection of flexible endoscopes. | |
Mar - July | Meetings- staff, lectures as in Sept 2008 + implementation. |
Fourth environmental sampling- 1/17, hand touch surface surgery unit pos (Table 2). | |
Written routines for ISO area revised. | |
Sep | MRSA case- pressure sore, foal kept in ISO. |
Fifth environmental sampling- 0/11 (Table 2). | |
Oct | Feedback- staff lecture, discussion hygiene policy. |
Sixth environmental sampling- 0/5 (Table 2). | |
2010 | |
Jan | Feedback- staff, feedback on pilot study and infection control/basic hygiene discussions |
Mar | MRSA case- SSI, horse kept in ISO. |
Seventh and eighth environmental sampling- 0/15 and 0/3 respectively (Table 2). | |
Apr | Ninth environmental sampling- ISO, 1/3, stall pos (Table 2). |
Continuing work; Revaluation, revision of routines, education, implementation etc . |