Abstract
The tolerance of certain multi-drug resistant bacteria to disinfectants may be promoted while the requirements of environmental disinfection have been raised in the high-risk areas of medical institutions during the COVID-19 pandemic. The current research addressed the mechanisms underlying a sharp increase in the detection of methicillin-resistant Staphylococcus aureus (MRSA) observed in a closed-management unit of elderly patients with mental disorders in 2020 as compared with the previous 4 years. We first conducted microbial detection in staff-hand and environment and a molecular epidemiology analysis, rejecting the hypothesis that the MRSA increase was due to an outbreak. Afterward, we turned to disinfectant concentration and frequency of use and analyzed the varied MRSA detection rates with different concentrations and frequencies of disinfection in 2020 and the previous 4 years. The MRSA detection rate increased with elevated concentration and frequency of disinfection, with 1,000 or 500 mg/L two times per day since January in 2020 vs. 500 mg/L 2–3 times per week in 2016–2019. When the disinfectant concentration was reduced from 1,000 to 500 mg/L, the MRSA detection decreased which indicated a modulatory role of disinfectant concentration. With a sustained frequency of disinfection in 2020, the MRSA detection rate was still higher, even after May, than that in the previous years. This suggested that the frequency of disinfection also contributed to the MRSA increase. Overall, the MRSA detection was augmented with the increase in disinfection concentration and frequency during the COVID-19 epidemic, suggesting that highly-concentrated and highly-frequent preventive long-term disinfection is not recommended without risk assessments in psychiatric hospitals.
Highlights
In December 2020, the first “variant under investigation” of the novel coronavirus was announced in the UK [1]
The recent infectious indicators of patients, such as white blood cell count (WBC), neutrophil percentage (NEU%), high-sensitivity C-reactive protein, procalcitonin (PCT), among others, were taken into consideration to determine whether patients had symptoms of infection
With the sustained frequency of disinfection in 2020, the methicillin-resistant Staphylococcus aureus (MRSA) detection rate was still higher, even after May, than that in the previous years, suggesting that frequency of disinfection contributed to the increase of the MRSA detection rate
Summary
In December 2020, the first “variant under investigation” of the novel coronavirus was announced in the UK [1]. Many countries have reported the rapid spread of new mutant viruses [2, 3]. The continuous deterioration of the global epidemic situation has destined the long-term and generalization of this epidemic prevention war. The proposal of “environmental transmission,” a new alternation of transmission, has raised the requirements of environmental disinfection to an unprecedented level. In medical institutions in highrisk areas, using disinfectants to disinfect “object surface and environment” is one of the core means to effectively control the iatrogenic infection [4,5,6,7]. If continuous sterilization with high concentration and high frequency is applied, it may increase disinfectant-resistant strains, especially methicillinresistant Staphylococcus aureus (MRSA) [8, 9]
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