Fitzpatrick F, Murphy O M, Brady A, Prout S, Fenelon L E
Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
J Hosp Infect. 2000 Dec;46(4):271-9. doi: 10.1053/jhin.2000.0838.
The control of hospital-acquired infection, in particular methicillin-resistant Staphylococcus aureus (MRSA) remains a challenge. Our hospital has established a purpose built 11-bed cohort unit with on-site rehabilitation for care of patients colonized with MRSA, in an attempt to improve their quality of care. Prior to the opening of this unit a number of concerns were voiced and the aim of this study was to address these. First, to establish if patient cohorting reduces the likelihood of successful decolonization, second, to evaluate the risk of staff colonization, and finally to see if successful environmental control of MRSA is possible.A patient database was established detailing patient demographics, infection rates, eradication and reacquisition rates. Staff screening was performed weekly, at the start of a period of duty. Sixty environmental sites were screened before unit opening, at 48h, six weeks and at six months. There were 88 admissions in the first six months; 62 patients were colonized with MRSA, and 26 patients (10 surgical, 16 medical) had MRSA infections. Twenty-three of 88 patients (26%) were successfully decolonized, which compares favourably with an eradication rate of 20% for the rest of the hospital. Twenty staff members participated in weekly screening. Five staff members colonized with MRSA were detected and all were successfully decolonized. Environmental control was achieved with a combination of a daily detergent clean and a once weekly clean with phenolic disinfectant. Our preliminary data suggest that, despite cohorting patients colonized with MRSA, with proper education and supervised cleaning protocols, it is possible to control environmental MRSA load, successfully decolonize patients and limit the risk of staff colonization.
控制医院获得性感染，尤其是耐甲氧西林金黄色葡萄球菌（MRSA）仍然是一项挑战。我们医院设立了一个专门的拥有11张床位的群组病房，并配有现场康复设施，用于护理感染MRSA的患者，旨在提高他们的护理质量。在该病房启用之前，人们提出了一些担忧，本研究的目的就是解决这些问题。首先，确定患者分组是否会降低成功清除定植菌的可能性；其次，评估工作人员被定植的风险；最后，查看是否能够成功实现对MRSA的环境控制。建立了一个患者数据库，详细记录患者的人口统计学信息、感染率、清除率和再感染率。在每个工作时段开始时，每周对工作人员进行筛查。在病房启用前、启用后48小时、六周和六个月时，对60个环境位点进行了筛查。头六个月有88名患者入院；62名患者感染了MRSA，26名患者（10名外科患者，16名内科患者）发生了MRSA感染。88名患者中有23名（26%）成功清除了定植菌，这一比例优于医院其他科室20%的清除率。20名工作人员参与了每周的筛查。检测到5名感染MRSA的工作人员，他们均成功清除了定植菌。通过每天使用清洁剂清洁和每周一次使用酚类消毒剂清洁相结合的方式实现了环境控制。我们的初步数据表明，尽管对感染MRSA的患者进行了分组，但通过适当的教育和有监督的清洁方案，有可能控制环境中的MRSA负荷，成功清除患者的定植菌并限制工作人员被定植的风险。
