Eveillard M, Leroy C, Teissiere F, Lancien E, Branger C, de Lassence A, Joly-Guillou M-L, Brun P
Service de Microbiologie-hygiène, Hôpital Louis Mourier (AP-HP), Colombes, France.
J Hosp Infect. 2006 Aug;63(4):380-4. doi: 10.1016/j.jhin.2006.02.020. Epub 2006 Jun 8.
Identification of the meticillin-resistant Staphylococcus aureus (MRSA) reservoir by active screening followed by the implementation of contact precautions is one of the major components of MRSA control programmes. The objective of this study was to evaluate the results of a programme of selective screening in an emergency department (ED) and the appropriateness of the contact precautions implemented. This was estimated by distinguishing necessary and unnecessary days of contact precautions. This estimation was performed for all days of contact precautions and, more specifically, for days of preventive contact precautions implemented before the availability of screening results. During a three-year period, screening of MRSA carriers was performed on 0.95% (N=605) of patients visiting the emergency ward. Among the 193 (31.9%) MRSA carriers identified, 159 were hospitalized in the short-length-hospitalization area (SLHA) of the ED and/or in other wards. Among the 140 patients admitted to the SLHA, 44 were hospitalized for at least 48 h, with a mean length of hospitalization of 5.9 days. The cumulative duration of hospitalization of carriers identified by screening was 1897 days. In total, 2370 days of contact precautions (including 924 days of preventive precautions) were implemented for patients screened in the ED. Considering the whole hospital, the appropriateness of this entire programme of contact precautions for patients screened in the ED was 80.0% (52.1% for the SLHA), whereas the specific appropriateness of preventive isolation days was 48.6% (43.6% for the SLHA). This study underscores the risk of MRSA cross-transmission in the SLHA, and the usefulness of implementing a control programme of screening carriers in the ED.
通过主动筛查确定耐甲氧西林金黄色葡萄球菌（MRSA）储存库，随后实施接触预防措施，是MRSA控制计划的主要组成部分之一。本研究的目的是评估急诊科（ED）的选择性筛查计划的结果以及所实施接触预防措施的适当性。这是通过区分接触预防措施的必要天数和不必要天数来估计的。对所有接触预防措施的天数进行了估计，更具体地说，是对在筛查结果出来之前实施的预防性接触预防措施的天数进行了估计。在三年期间，对到急诊科就诊的0.95%（N = 605）的患者进行了MRSA携带者筛查。在确定的193名（31.9%）MRSA携带者中，有159人在急诊科的短期住院区（SLHA）和/或其他病房住院。在入住SLHA的140名患者中，有44人住院至少48小时，平均住院时间为5.9天。通过筛查确定的携带者的累计住院时间为1897天。总共对在急诊科筛查的患者实施了2370天的接触预防措施（包括924天的预防性预防措施）。考虑到整个医院，对在急诊科筛查的患者实施的这一整套接触预防措施的适当性为80.0%（SLHA为52.1%），而预防性隔离天数的具体适当性为48.6%（SLHA为43.6%）。本研究强调了SLHA中MRSA交叉传播的风险，以及在急诊科实施携带者筛查控制计划的有用性。
