Hartstein A I, LeMonte A M, Iwamoto P K
Division of Infectious Diseases, Indiana University Medical Center, Indianapolis, USA.
Infect Control Hosp Epidemiol. 1997 Jan;18(1):42-8. doi: 10.1086/647500.
To describe control of endemic and outbreak-related methicillin-resistant Staphylococcus aureus (MRSA) at two affiliated hospitals.
Prospective surveillance of patients with MRSA. Disposable gloves were used by all staff having direct contact with the affected patient or his immediate environment, and patient isolates were typed by pulsed-field gel electrophoresis (PFGE) of genomic DNA. Surveillance and PFGE typing were used concurrently to identify possible nosocomial outbreaks, confirm or refute cross-infection, and support a need for additional outbreak control interventions.
A university hospital (Hospital A) and a university-affiliated public hospital (Hospital B).
Patients with MRSA colonization or infection over an 18-month interval (June 1993-November 1994).
Proper handwashing and gloving practices were reemphasized with staff following confirmation of outbreaks.
Hospital A had 60 community-acquired and 48 nosocomial cases of MRSA. Two small outbreaks (affecting a total of seven patients) and two pseudo-outbreaks were identified. Hospital B had 36 community-acquired and 22 nosocomial cases of MRSA. Only one outbreak affecting five patients occurred. All outbreaks ended shortly after staff meetings that emphasized ongoing and extremely careful handwashing and gloving when caring for identified patients. The majority of nosocomial cases at both hospitals were not related epidemiologically or had isolates with unique PFGE types. Pseudo-outbreaks were confirmed by demonstrating that isolates from epidemiologically related cases (by time and clinical service or hospital unit) had different PFGE types. Hospital A cases had 39 different PFGE types, and Hospital B cases had 31 different PFGE types.
MRSA in hospitals, including outbreaks identified by prospective surveillance and confirmed by PFGE typing, can be controlled by minimal special precautions and interventions. This is possible despite the continuous admission of patients with MRSA from the community. PFGE typing is useful to confirm outbreaks and pseudo-outbreaks, demonstrate differences among epidemiologically unrelated isolates, and substantiate the efficacy of MRSA control programs within hospitals.
描述两家附属医院对地方性及与暴发相关的耐甲氧西林金黄色葡萄球菌（MRSA）的控制情况。
对MRSA患者进行前瞻性监测。所有直接接触感染患者或其直接环境的工作人员均使用一次性手套，通过对基因组DNA进行脉冲场凝胶电泳（PFGE）对患者分离株进行分型。同时使用监测和PFGE分型来识别可能的医院感染暴发，确认或排除交叉感染，并支持采取额外的暴发控制干预措施。
一家大学医院（A医院）和一家大学附属医院（B医院）。
18个月期间（1993年6月至1994年11月）的MRSA定植或感染患者。
在确认暴发后，对工作人员再次强调正确的洗手和戴手套做法。
A医院有60例社区获得性MRSA病例和48例医院感染病例。识别出两起小暴发（共影响7名患者）和两起假暴发。B医院有36例社区获得性MRSA病例和22例医院感染病例。仅发生了一起影响5名患者的暴发。在强调对确诊患者进行持续且极其仔细的洗手和戴手套操作的工作人员会议后不久，所有暴发均结束。两家医院的大多数医院感染病例在流行病学上无关，或分离株具有独特的PFGE类型。通过证明来自流行病学相关病例（按时间、临床科室或医院病房）的分离株具有不同的PFGE类型，确认了假暴发。A医院的病例有39种不同的PFGE类型，B医院的病例有31种不同的PFGE类型。
医院内的MRSA，包括通过前瞻性监测识别并经PFGE分型确认的暴发，可通过最少的特殊预防措施和干预措施得到控制。尽管社区中持续有MRSA患者入院，但这仍是可行的。PFGE分型有助于确认暴发和假暴发，显示流行病学无关分离株之间的差异，并证实医院内MRSA控制项目的有效性。
