A 42-year-old female presented to the emergency department with a left-sided weakness and was admitted to the hospital. A computerized tomography (CT) scan of her brain showed a space-occupying lesion. Five days into her admission, the patient had a brain biopsy of her space-occupying lesion. Her condition deteriorated, and she required a decompressive craniotomy and admission to the intensive care unit (ICU), where she was intubated and required mechanical ventilation and central venous access. In order to monitor her intracranial pressure, an intracranial pressure probe (ICP) was inserted in theatre. Her methicillin-resistant Staphylococcus aureus (MRSA) triple-site screening swabs on admission to the ICU were negative.
The patient required further surgical interventions, and a ventriculoperitoneal (VP) shunt was inserted. She remained in the ICU for three weeks and was later discharged to the general unit. On admission to the unit, a repeat MRSA triple-site screening swab was reported as being positive. Then, 48 hours later, the patient spiked a temperature of 39°C and further dropped her Glasgow coma scale (GCS). The doctor was asked to review her case. Her examination was unremarkable for the cardiovascular and respiratory system, but he noted small blistering on the right forearm at the peripheral vascular access site. Blood cultures were taken from the patient and she was started on vancomycin for a possible cellulitis caused by MRSA.
The next morning, the microbiologist called, informing the clinical team that the patient’s blood culture was growing Gram-positive cocci in clusters in both the aerobic and anaerobic bottles, probably indicative of MRSA. The organism was fully identified 24 hours later as MRSA.
INVESTIGATION OF THE CASE
MRSA bloodstream infections are considered preventable and avoidable healthcare-associated infections.
Adapted from Chand M. (2017). Case studies in infection control. Taylor & Francis Group
What implications could this infection have for the unit and hospital as a whole? As part of the IPC team what essential steps would you apply to thoroughly investigate this infection event? In addition what infection prevention and control interventions could be implemented to manage this healthcare-associated infection and minimize spread?
MRSA bloodstream infections