Jaqua-Stewart M J, Tjaden J, Humphreys D W, Bade P, Tille P M, Peterson K G, Salem A G
S D J Med. 1999 Jul;52(7):241-7.
For the month of October, 1993, the Methicillin-Resistant Staphylococcus aureus nosocomial infection rate in our 42-bed Extended Care Unit/Nursing Home was 33% (8.5% for the 1993 year). Our facility was committed to decrease colonization and infection rates and to prevent the introduction of additional colonized patients into the closed environment. Methicillin-Resistant Staphylococcus aureus containment practices were instituted and consisted of total population and staff surveillance, aggressive containment measures and followed by maintenance containment protocols. The aggressive plan included contact isolation, baths with chlorhexagluconate, treatment of nasal carriers with mupiricin and treatment of both colonized and infected patients. This was followed by maintenance measures of screening new admissions for Methicillin-Resistant Staphylococcus aureus with contact isolation and treatment for positive as described during the aggressive phase. Total population surveillance was repeated after one year. Results showed that no employees were colonized with Methicillin-Resistant Staphylococcus aureus. The initial colonization rate in residents/patients was 52%. After one year the colonization rate dropped to 2% and the infection rate to 1.4%. Molecular epidemiology demonstrated that there was limited acquisition of new strains of Methicillin-Resistant Staphylococcus aureus within the Extended Care Unit. The process was shown to be cost effective. Aggressive containment practices applied to a nursing home with a high Methicillin-Resistant Staphylococcus aureus infection rate not only reduced rates of colonization, but also markedly reduced infections. This reduction was maintained over time.
1993年10月，我们拥有42张床位的长期护理病房/养老院耐甲氧西林金黄色葡萄球菌医院感染率为33%（1993年全年为8.5%）。我们的机构致力于降低定植率和感染率，并防止更多定植患者进入封闭环境。采取了耐甲氧西林金黄色葡萄球菌控制措施，包括对全体人员和工作人员进行监测、积极的控制措施以及后续的维持控制方案。积极的计划包括接触隔离、用葡萄糖酸洗必泰洗澡、用莫匹罗星治疗鼻腔携带者以及治疗定植和感染患者。随后采取维持措施，即对新入院患者进行耐甲氧西林金黄色葡萄球菌筛查，如积极阶段所述进行接触隔离并对阳性患者进行治疗。一年后对全体人员再次进行监测。结果显示，没有员工被耐甲氧西林金黄色葡萄球菌定植。居民/患者的初始定植率为52%。一年后，定植率降至2%，感染率降至1.4%。分子流行病学表明，长期护理病房内新的耐甲氧西林金黄色葡萄球菌菌株的获得有限。该过程被证明具有成本效益。对耐甲氧西林金黄色葡萄球菌感染率高的养老院采取积极的控制措施，不仅降低了定植率，而且显著降低了感染率。这种降低随着时间的推移得以维持。
