Adoption of a Tertiary Hospital MRSA Outbreak Management Algorithm for Effective Containment of an EMRSA-15 (ST22-IV) Cluster in a Rehabilitation Ward

Ms Rosie Lee1, Mr Simon Meyer-Henry1

1Royal Perth Hospital, Perth, Australia


In WA, for 2015-2016, Healthcare-associated MRSA (HA-MRSA) accounted for 23% of MRSA HAIs. Of these 92% were EMRSA-15 (ST22-IV), a significant strain in the hospital setting.


In February 2017, 1 case of EMRSA-15 infection was detected from a patient in an aged care rehabilitation ward in a metropolitan non-tertiary hospital. The Infection Prevention Unit was notified of a second case of EMRSA-15 colonisation detected in an inpatient screened whilst attending an outpatient appointment at another facility.

In 2016, the non-tertiary hospital amalgamated with the tertiary hospital and infection control policies aligned. Consequently, the detection of 2 EMRSA-15 cases led to an epidemiological investigation using the tertiary hospital’s MRSA outbreak management algorithm. The control strategies included isolation of positive patients, screening requirements and environmental cleaning.

A 2014 publication based on a retrospective review of MRSA outbreaks at the tertiary hospital supported the introduction of early screening and decolonisation of Healthcare Workers (HCW) to control EMRSA-15 outbreaks.


Investigation identified the 2nd case had been admitted into a bed space previously occupied by the index case, and vacated only minutes earlier. Requisite screening of ward contacts identified an additional patient with EMRSA-15 infection. Consequent screening of 72 HCWs detected 3 EMRSA-15 staff cases, who received topical MRSA decolonisation treatment.


In non-tertiary settings cases of clinical infection with EMRSA-15 should be investigated and strategies employed to curb transmission. Along with identification of colonised patients, early identification and treatment of HCWs may be warranted to swiftly contain the EMRSA-15 cluster.


Rosie is the Coordinator of the Infection Prevention & Management Unit in a tertiary hospital in WA. She is a Credentialed ICP with over 25 years extensive experience in infection prevention. She has co-authored several articles for both Australian and International Medical Journals. Rosie is actively involved and committed to professional development and has served as President for the State Associations prior to the formation of ACIPC. She was a member of the Colleges’ Credentialing Committee and Chair of the 2014 Conference Organising Committee. She also served on the ACSQHC HAI Implementation Advisory Committee and HAI Technical Advisory Group.

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