Barakate M S, Yang Y X, Foo S H, Vickery A M, Sharp C A, Fowler L D, Harris J P, West R H, Macleod C, Benn R A
Division of Surgery, Royal Prince Alfred Hospital, NSW, Australia.
J Hosp Infect. 2000 Jan;44(1):19-26. doi: 10.1053/jhin.1999.0635.
Over a 30-month period from July 1995 to December 1997, new detections of methicillin-resistant Staphylococcus aureus (MRSA) were prospectively studied in a tertiary referral hospital. The aims of the study were to determine the incidence of colonization of patients admitted to each of the hospital's 39 clinical units and ascertain where each patient had become colonized. Epidemiological information (time to detection, ward movement, admission to other hospitals, data on MRSA isolations in hospital wards) and phage typing were used by the hospital's infection control unit to make this determination. Routine containment procedures included cohorting, flagging and triclosan body washes. Surveillance cultures were collected infrequently. Patients known to be colonized with MRSA were excluded from orthopaedic and haematology wards. During the study period, 995 patients were found to be newly colonized. The incidence of colonization varied from nil to 72 per 1000 admissions, being highest in the main intensive care unit and in services which frequently used that unit. The incidence of colonization in elective orthopaedic surgery (< 1 per 1000) and haematology (3 per 1000) was very low. Determining the place where patients acquired MRSA was made difficult by the high frequency of endemic phage types and frequent patient transfer between wards. Epidemiological data suggested that the main intensive care unit and surgical wards nursing patients with colorectal, urological and vascular diseases were the places where most patients became colonized. MRSA was never acquired by patients nursed in wards which practised an exclusion policy towards patients known to be colonized with MRSA. Our data suggest that in tertiary referral hospitals, where MRSA is not only endemic but frequently imported from other hospitals, it is possible to establish areas where MRSA is never acquired.
在1995年7月至1997年12月的30个月期间，对一家三级转诊医院耐甲氧西林金黄色葡萄球菌（MRSA）的新检出情况进行了前瞻性研究。该研究的目的是确定该医院39个临床科室收治患者的定植发生率，并确定每位患者的定植部位。医院感染控制部门利用流行病学信息（检测时间、病房转移情况、转至其他医院情况、医院病房MRSA分离数据）和噬菌体分型来做出这一判断。常规控制措施包括分组护理、标记和使用三氯生沐浴液。很少采集监测培养样本。已知感染MRSA的患者被排除在骨科和血液科病房之外。在研究期间，发现995例患者新发生定植。定植发生率从每1000例入院患者中0例到72例不等，在主要重症监护病房以及经常使用该病房的科室中最高。择期骨科手术（每1000例中<1例）和血液科（每1000例中3例）的定植发生率非常低。由于流行噬菌体类型的高频率以及病房之间患者的频繁转移，确定患者获得MRSA的地点变得困难。流行病学数据表明，主要重症监护病房以及护理结直肠、泌尿和血管疾病患者的外科病房是大多数患者发生定植的地方。在对已知感染MRSA的患者实施排除政策的病房中护理的患者从未感染过MRSA。我们的数据表明，在不仅MRSA为地方流行且经常从其他医院传入的三级转诊医院中，有可能建立从未发生MRSA感染的区域。
