Mylotte J M, Karuza J, Bentley D W
Department of Medicine, State University of New York, Buffalo.
Infect Control Hosp Epidemiol. 1992 Dec;13(12):711-8. doi: 10.1086/648344.
To determine the frequency of recognition of methicillin-resistant Staphylococcus aureus (MRSA) as an infection control problem and its prevalence among long-term care facilities, and to evaluate whether certain long-term care facility characteristics such as bed size, ownership, level of infection control activity, and frequency of resident transfers to acute care hospitals are related to the recognition or prevalence of MRSA in this setting.
Questionnaire survey.
Seventy-five long-term care facilities in the 8 counties of western New York.
Seventy-five of 81 (92.6%) long-term care facilities returned a completed questionnaire. Seventy-nine percent were considered to have a "limited" level of infection control activity (part-time infection control practitioner who spent less than 10 hours a week on infection control activities). The larger the long-term care facility, the more time was spent on infection control activities (p = .01). Seventy-two percent of the long-term care facilities screened new admissions for MRSA by reviewing culture reports; 69% of the long-term care facilities had a specific infection control policy for MRSA. Sixteen of the 75 (21%) facilities felt they had an infection control problem with MRSA. By univariate analysis, the only characteristic significantly associated with this recognition was use of nurse practitioners or physician assistants by a facility (p < .05). Eighty-one percent of the 75 long-term care facilities had identified one or more patients with MRSA in the year prior to the survey. By univariate analysis, the only characteristics that were significantly associated with the number of residents with MRSA were the monthly average number of residents transferred to acute care facilities (p = .034) and facility bed size (p = .022); there was also a trend toward increasing intensity of infection control activities (p = .085). However, facility bed size and the average number of resident transfers per month to acute care facilities were strongly associated (p = .0002). By stepwise logistic regression analysis, only bed size was an independent predictor of the number of residents with MRSA. Many long-term care facilities had tried to eradicate MRSA; ciprofloxacin was most commonly used to eradicate MRSA.
The vast majority of the 75 long-term care facilities in the 8 counties of western New York have identified patients with MRSA, although only a minority (21%) of them actually believed that an infection control problem existed. Facility size (a surrogate for the monthly average number of resident transfers to acute care facilities) seems to be an important factor in determining the number of residents with MRSA in long-term care facilities in our geographic region. The major longitudinal studies of MRSA in such facilities have so far been done only in Veterans Affairs facilities. Further studies are needed in freestanding long-term care facilities, the largest group of long-term care facilities in the United States, to determine the epidemiology of MRSA in this setting and to develop practical and valid infection control methods for residents with MRSA.
确定耐甲氧西林金黄色葡萄球菌（MRSA）作为感染控制问题的认知频率及其在长期护理机构中的流行情况，并评估某些长期护理机构特征，如床位规模、所有权、感染控制活动水平以及居民转至急性护理医院的频率，是否与该环境中MRSA的认知或流行有关。
问卷调查。
纽约西部8个县的75家长期护理机构。
81家长期护理机构中有75家（92.6%）返回了完整的问卷。79%的机构被认为感染控制活动水平为“有限”（兼职感染控制从业者每周花费不到10小时进行感染控制活动）。长期护理机构规模越大，在感染控制活动上花费的时间越多（p = 0.01）。72%的长期护理机构通过审查培养报告对新入院患者进行MRSA筛查；69%的长期护理机构有针对MRSA的特定感染控制政策。75家机构中有16家（21%）认为他们存在MRSA感染控制问题。通过单因素分析，与这种认知显著相关的唯一特征是机构使用执业护士或医师助理（p < 0.05）。75家长期护理机构中有81%在调查前一年已识别出一名或多名MRSA患者。通过单因素分析，与MRSA患者数量显著相关的唯一特征是每月转至急性护理机构的居民平均数量（p = 0.034）和机构床位规模（p = 0.022）；感染控制活动强度也有增加的趋势（p = 0.085）。然而，机构床位规模与每月转至急性护理机构的居民平均数量密切相关（p = 0.0002）。通过逐步逻辑回归分析，只有床位规模是MRSA患者数量的独立预测因素。许多长期护理机构曾试图根除MRSA；环丙沙星是最常用于根除MRSA的药物。
纽约西部8个县的75家长期护理机构中的绝大多数已识别出MRSA患者，尽管其中只有少数（21%）实际认为存在感染控制问题。机构规模（每月转至急性护理机构的居民平均数量的替代指标）似乎是决定我们地理区域长期护理机构中MRSA患者数量的一个重要因素。迄今为止，此类机构中关于MRSA的主要纵向研究仅在退伍军人事务机构中进行。需要在独立的长期护理机构（美国最大的长期护理机构群体）中进行进一步研究，以确定该环境中MRSA的流行病学，并为MRSA患者制定切实可行且有效的感染控制方法。
