Use of infection control procedures in an out-patient clinic for leg ulcers and the rate of contamination with methicillin-resistant Staphylococcus aureus

There is a gradual, worldwide increase in the development of resistant bacteria. The presence of resistant species on an ulcer bed has specific ramifications with regard to the risk of their environmental spread, as well as to the healing of the affected ulcer. Objective: The objective of this study was to evaluate the efficacy of accepted infection-control procedures in a clinic for cutaneous ulcers. Main outcome measure: Presence of methicillin-resistant Staphylococcus aureus (MRSA) was the main outcome measure of the study. Methods: Patients with leg ulcers of various etiology were included in the study. Since June of 1999, strict implementation of infection-control procedures, according to the United States Centers for Disease Control and Prevention (CDC) guidelines valid at that time, have been carried out in the Out-Patient Clinic for Leg Ulcers of Soroka University Medical Center in Beer-Sheba, Israel. Up to June of 1999, the infection control policy had been rather inconsistent. Two groups of patients were included. The first group included 34 patients, treated from January, 1996, to December, 1998; the second group included 83 patients, treated from January, 2000, to December, 2002. Swabs for bacterial cultures were taken from the ulcer bed from each patient at 2- to 4-week intervals. We compared the two groups with respect to number of patients with positive MRSA isolation, time until MRSA isolation, and presence of risk factors for colonization of MRSA. Results: In the first group (1996-1998), 5 of 34 patients (14.7%) were contaminated with MRSA during their visits to the clinic. In these five patients the mean time from their visit until MRSA isolation was 21 months. In the second group (2000-2002), in 7 of 83 patients (8.4%) were contaminated with MRSA during their visits to the clinic. In these seven patients the mean time from their visit until MRSA isolation was 13.2 months. No statistically significant differences were identified when comparing risk factors for MRSA colonization between these two groups.The relative reduction in the number of patients with positive isolation of MRSA and in the time until its isolation was not found to be statistically significant. Conclusion: Strict implementation of infection-control guidelines is a reasonable and desirable procedure in the treatment of patients with leg ulcers. It may reduce transmission rate of pathogenic bacteria from one patient to another. Further research studies with larger populations of patients are required. Use of these guidelines is a basic element of appropriate and reasonable treatment in patients with cutaneous ulcers.