Combating MRSA Outbreaks in Hong Kong Hospitals: Protecting Infants and Implementing Innovative Prevention Strategies

The recent outbreaks of Methicillin-resistant Staphylococcus aureus (MRSA) among infants in Hong Kong hospitals have raised concerns among healthcare professionals and parents alike. MRSA is a type of bacteria that is resistant to several commonly used antibiotics, making it challenging to treat and control in healthcare settings. In this blog post, we will discuss the current situation in Hong Kong hospitals, the potential impact of MRSA infections on infants, and the preventive measures being taken to combat the spread of this dangerous pathogen.

From January to April 2024, a cumulative total of 14 infants were diagnosed with MRSA at Kwong Wah Hospital, prompting the temporary suspension of new admissions to prevent further spread. Recently, a 14-day-old baby girl from Tuen Mun Hospital’s Neonatal Intensive Care Unit was identified as a carrier of MRSA without symptoms of infection. After screenings, six more babies (three boys and three girls, aged 6 days to 5 months) of the same ward were confirmed to be MRSA carriers without any symptoms of infection. All of whom are currently receiving isolated treatment (Source: Bastillepost, 2024; HK01, 2024). These outbreaks highlight the highly infectious nature of MRSA and the need for heightened vigilance and effective infection control measures in healthcare facilities, especially those caring for vulnerable populations such as infants.

Impact of MRSA on Infants
MRSA can cause a range of serious infections in infants, including bloodstream infections, skin and soft tissue infections, pneumonia, and meningitis. These infections can lead to prolonged hospitalizations, increased need for aggressive treatments, and potential long-term health complications for affected patients (Source: SHEA/IDSA/APIC Practice Recommendation, 2022). The immature immune systems of infants make them particularly susceptible to the severe consequences of MRSA infections, underscoring the importance of preventing transmission in healthcare settings.

Prevention Strategies
Exposure to contaminated environment has been associated with acquisition of MRSA. MRSA contaminates the patient environment (e.g. overbed tables, bedrails, furniture, sinks, floors) and patient care equipment. Similar to the our findings in elderly homes, MRSA contamination on surfaces around the patient zone varies in bioburden concentration.

To combat the spread of MRSA, medical and healthcare facilities are implementing rigorous infection control measures in accordance with established guidelines. These measures include:

1. Enhanced screening and monitoring of patient health

2. Thorough cleaning and disinfection of wards

3. Strict adherence to contact transmission prevention protocols

4. Educating healthcare professionals, patients, and families about MRSA and proper hand hygiene

The "SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update" outlines essential practices for preventing MRSA transmission in healthcare settings. On one hand, they stressed the importance of proper cleaning and disinfection of equipment and the environment as improvements in environmental cleaning have been associated with reductions in MRSA acquisition by preventing transmission of multiple pathogens. On the other, they emphasized the importance of risk assessment “to evaluate the facility for transmission risks and to assess the effectiveness of other MRSA risk mitigation strategies (e.g., hand hygiene, cleaning and disinfection of the environment, single occupancy patient rooms) and should establish a process for ongoing monitoring, oversight, and risk assessment” (Source: SHEA/IDSA/APIC Practice Recommendation, 2022).

The Role of Proper Disinfection and Indoor Environmental Hygiene Assessment
Studies have suggested that patients may be persistent MRSA carriers for prolonged periods (median duration in one study, 8.5 months). Persistent, consistent and sustainable cleaning and disinfection practice can be achieved with smart robotics like Whiz Gambit, along with premium hospital-grade disinfectants like Nanocyn. Our studies in medical and healthcare sectors demonstrated its effectiveness, contributing to the health and safety of patients/residents and staff.

In addition, hospitals should conduct a MRSA risk assessment based on internal infection rates, local epidemiology, hospital infrastructure (eg, proportion of non-private patient room) that may contribute to patient-to-patient transmission of MRSA if contact precautions are not used, and other factors. When making the decision to discontinue contact precautions for all or a subset of patients with MRSA, a facility should establish a policy and process that supports and communicates this change. Avalon Steritech’s IEH assessment is designed to assist the medical and healthcare management to address this issue. The assessment results can provide a quantitative and objective data that supports the decision whether to continue the contact precautions while demonstrating their effectiveness. To ensure the safety of staff and the patients or residents, active surveillance is particularly crucial to high-risk populations including:

1. 1. ICU patients

2. 2. NICU patients

3. 3. Burn-unit patients

4. 4. Dialysis patients

5. 5. Transplant and other specialty units with immunocompromised patients

6. 6. Patients with indwelling devices such as central venous catheters

7. 7. Patients with active infections, particularly those with uncontained wounds or secretions

8. 8. Residents of long-term acute-care hospitals

9. 9. Residents of long-term care facilities

Conclusion
The recent MRSA outbreaks in Hong Kong hospitals serve as a reminder of the importance of robust infection control measures and the need for innovative solutions to prevent the spread of dangerous pathogens. By implementing comprehensive prevention strategies, utilizing smart technologies like Whiz Gambit and Nanocyn, along with advanced surveillance tools such as indoor environmental hygiene assessment, we can work towards protecting our most vulnerable patients and ensuring a safer healthcare environment for all.

Sources:

1. Bastillepost. (2024). Cluster of Methicillin-resistant Staphylococcus aureus cases in Tuen Mun Hospital. Retrieved from https://www.bastillepost.com/global/article/3806188-cluster-of-methicillin-resistant-staphylococcus-aureus-cases-in-tuen-mun-hospital

2. HK01. (2024). 超級細菌｜廣華醫院累計14嬰兒染抗藥性金黃葡萄球菌　暫停收新症. Retrieved from https://www.hk01.com/%E7%A4%BE%E6%9C%83%E6%96%B0%E8%81%9E/1011996/%E8%B6%85%E7%B4%9A%E7%B4%B0%E8%8F%8C-%E5%BB%A3%E8%8F%AF%E9%86%AB%E9%99%A2%E7%B4%AF%E8%A8%8814%E5%AC%B0%E5%85%92%E6%9F%93%E6%8A%97%E8%97%A5%E6%80%A7%E9%87%91%E9%BB%83%E8%91%A1%E8%90%84%E7%90%83%E8%8F%8C-%E6%9A%AB%E5%81%9C%E6%94%B6%E6%96%B0%E7%97%87

3. SHEA/IDSA/APIC Practice Recommendation. (2022). Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update. Retrieved from https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/sheaidsaapic-practice-recommendation-strategies-to-prevent-methicillinresistant-staphylococcus-aureus-transmission-and-infection-in-acutecare-hospitals-2022-update/0E86290F644F4EBBC9B8E46C36F5C446