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Logo of actavetsBioMed CentralBiomed Central Web Sitesearchsubmit a manuscriptregisterthis articleActa Veterinaria Scandinavica
Acta Vet Scand. 2012; 54(1): 14.
Published online Mar 8, 2012. doi:  10.1186/1751-0147-54-14
PMCID: PMC3325856
Infection prevention and control interventions in the first outbreak of methicillin-resistant Staphylococcus aureus infections in an equine hospital in Sweden
Karin Bergström,corresponding author1,4 Görel Nyman,1 Stefan Widgren,2 Christopher Johnston,3 Ulrika Grönlund-Andersson,4 and Ulrika Ransjö5
1Department of Animal Environment and Health, Faculty of Veterinary Medicine and Animal Husbandry, Swedish University of Agricultural Sciences, SE 750 07 Uppsala, Sweden
2Department of Disease Control and Epidemiology, SVA, SE 750 89 Uppsala, Sweden
3Equine Clinics, University Animal Hospital, University of Agricultural Sciences, SE 750 07 Uppsala, Sweden
4Department of Animal Health and Antimicrobial Strategies, SVA, SE 750 89 Uppsala, Sweden
5Department of Clinical Microbiology, Uppsala University Hospital, SE 751 85 Uppsala, Sweden
corresponding authorCorresponding author.
Karin Bergström: karin.bergstrom/at/; Görel Nyman: gorel.nyman/at/; Stefan Widgren: stefan.widgren/at/; Christopher Johnston: christopher.johnston/at/; Ulrika Grönlund-Andersson: ulrika.gronlund-andersson/at/; Ulrika Ransjö: ulrika.ransjo/at/
Received October 11, 2011; Accepted March 8, 2012.
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.
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.
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.
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.
Keywords: Methicillin-resistant Staphylococcus aureus, MRSA, Infection control, Basic hygiene, Equine, Outbreak, Environment, Interventions
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