Brandt C, Jahn-Mühl B, Parthé S, Pitten F, Merbs R, Heudorf U
Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum Frankfurt am Main.
Rehabilitation (Stuttg). 2012 Aug;51(4):254-8. doi: 10.1055/s-0032-1312661. Epub 2012 Jun 29.
The German national guideline to prevent the spread of MRSA in acute care hospitals demands isolation of patients with MRSA, whereas a guideline for management of MRSA/MRDO-patients in rehabilitation is pending. Many rehabilitation clinics believe they should isolate these patients and therefore deny rehabilitation of this patient group arguing that rehabilitation and isolation are incompatible. In order to improve the rehabilitation of MDRO-patients the MDRO network Rhein-Main has developed a recommendation for rehabilitation clinics.Based on literature data on the prevalence of MRSA/MDRO in rehabilitation clinics, the data on transmission of MDRO in such clinics and on existing recommendations, a new recommendation was established by experts in hygiene and by management of rehabilitation clinics in the region.Current studies in Germany as well as in France exhibit the same prevalence of MDRO patients in rehabilitation units as well as in acute care clinics. Transmission occurs mainly via hand contact during patient care or medical therapy in critically ill patients with high maintenance. However, the risk of transmissions in patients with great mobility is not increased. Hence, good standard hygiene, especially good hand hygiene both in staff and patients, is the key method to prevent transmission. Isolation or other restriction of mobility does not seem necessary. These data formed the basis of the newly established recommendation, which sets out in a clearly laid-out and tabular manner the standard hygiene procedures necessary for safe rehabilitation of all patients and the additional measures necessary for rehabilitation of MDRO-patients. The recommendation provides guidance and thus will enable a better rehabilitation of MDRO-patients.
德国预防急性护理医院耐甲氧西林金黄色葡萄球菌（MRSA）传播的国家指南要求对MRSA患者进行隔离，而针对康复机构中MRSA/多重耐药菌（MRDO）患者的管理指南仍在制定中。许多康复诊所认为他们应该隔离这些患者，因此拒绝为该患者群体提供康复治疗，理由是康复和隔离不相容。为了改善MDRO患者的康复情况，莱茵-美因MDRO网络为康复诊所制定了一项建议。基于康复诊所中MRSA/MRDO患病率的文献数据、此类诊所中MDRO传播的数据以及现有建议，该地区的卫生专家和康复诊所管理人员制定了一项新的建议。德国以及法国目前的研究表明，康复机构和急性护理诊所中MDRO患者的患病率相同。传播主要发生在对重病且护理需求高的患者进行护理或药物治疗期间的手部接触。然而，活动能力强的患者传播风险并未增加。因此，良好的标准卫生措施，尤其是工作人员和患者都保持良好的手部卫生，是预防传播的关键方法。似乎没有必要进行隔离或其他行动限制。这些数据构成了新制定建议的基础，该建议以清晰明了的表格形式列出了所有患者安全康复所需的标准卫生程序以及MDRO患者康复所需的额外措施。该建议提供了指导意见，从而将使MDRO患者能够得到更好的康复。
