Heudorf Ursel, Berres Marlene, Hofmann Sabine, Steul Katrin
MDRO Network Rhine-Main, Frankfurt/Main, Germany.
Public Health Authority Frankfurt am Main, Frankfurt/Main, Germany.
GMS Hyg Infect Control. 2020 Jul 3;15:Doc15. doi: 10.3205/dgkh000350. eCollection 2020.
Multidrug-resistant organisms (MDRO) are a problem in medical facilities, including rehabilitation facilities in Germany. The national recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) for prevention of and dealing with patients affected by MDRO are obligatory in rehabilitation facilities. A survey on the management of patients with MDRO in rehabilitation facilities in the Rhine-Main area is presented below. The questions from a recently published survey in 45 rehabilitation facilities in 26 European countries (Doherty et al., 2019) were largely adopted unchanged: the type, size, and organization of the facility, availability of guidelines on MDRO, screening and (estimated) prevalence of MDRO, as well as special hygiene measures or restrictions for patients with MDRO. 22 of the 43 institutions contacted participated (58%). All facilities had specific recommendations on how to deal with MDRO and more than 95% had adequate hygiene staff. The facilities encompassed 4,369 beds, with 3,909 (89%) of them in single-bed rooms, and only a few offered 3-bed rooms. About 20% of patients in general rehabilitation and 100% in early neurological rehabilitation are screened on admission. Six (27%) facilities refused to accept patients with MDRO. 40% of the facilities treated these patients in their own room and/or in a separate area. 27% of the facilities prohibited eating in the dining room and participating in hydrotherapy. Only 6 (27%) of the rehabilitation centers indicated that patients with MDRO are allowed to participate in full rehabilitation programs. In accordance with the results of Doherty et al. (2019), there were many restrictions for rehabilitation patients with MDRO, indicating considerable need for improvement. Necessary hygiene recommendations to avoid the transmission of MDRO must not lead to rejection of inpatient rehabilitation or to less intensive rehabilitation.
多重耐药菌（MDRO）是医疗机构面临的一个问题，德国的康复机构也不例外。医院卫生与感染预防委员会（KRINKO）关于预防和处理受MDRO影响患者的国家建议在康复机构中具有强制性。以下是对莱茵 - 美因地区康复机构中MDRO患者管理情况的一项调查。来自最近在26个欧洲国家的45家康复机构开展的一项调查（多尔蒂等人，2019年）中的问题在很大程度上未作修改直接采用：机构的类型、规模和组织架构，MDRO相关指南的可用性，MDRO的筛查情况及（估计）流行率，以及针对MDRO患者的特殊卫生措施或限制。联系的43家机构中有22家参与了调查（58%）。所有机构都有关于如何处理MDRO的具体建议，超过95%的机构有足够的卫生工作人员。这些机构共有4369张床位，其中3909张（89%）为单人病房，只有少数提供三人病房。一般康复患者中约20%在入院时接受筛查，早期神经康复患者中100%在入院时接受筛查。6家（27%）机构拒绝接收MDRO患者。40%的机构在患者自己的房间和/或单独区域对这些患者进行治疗。27%的机构禁止患者在餐厅用餐和参加水疗。只有6家（27%）康复中心表示允许MDRO患者参加全面的康复项目。根据多尔蒂等人（2019年）的研究结果，MDRO康复患者面临诸多限制，这表明有很大的改进需求。避免MDRO传播的必要卫生建议绝不能导致住院康复患者被拒收或康复强度降低。
