Infection control measures and prevalence of multidrug-resistant organisms in non-hospital care settings in northeastern Germany: results from a one-day point prevalence study

Abstract

Much of the existing literature on the epidemiology of multidrug-resistant bacterial organisms (MDROs) and infection control measures still concentrates on hospital care settings. To pilot a cross-sectional survey in long-term care facilities (LTCFs), rehabilitation clinics, and homecare services to assess the prevalence of MDROs, structural data on infection control, and referral links between care settings in the state of Mecklenburg-West Pomerania,Germany, in 2015. A voluntary, anonymous, point prevalence survey, using routine microbiological and structural data (MDRO screening strategies) and the compliance of referring facilities with MRDO patient transfer sheets that are mandatory in Germany. Data from 39 facilities including 24 LTCFs, nine rehabilitation clinics, and six homecare services were analysed. The most reported pathogen was meticillin-resistant Staphylococcus aureus (MRSA) with a prevalence of 2.09% in homecare services, 1.43% in LTCFs, and 0.53% in rehabilitation clinics. Missing information on the MRDO status in the referral documents was a relevant problem in all facility types. Our results imply strong epidemiological links between acute care hospitals and non-clinical care settings. This underlines that successful efforts to curb antimicrobial resistance must not be limited to single facilities but include different settings that are linked by referral networks. Compared to surveys in clinical settings that used the same approach, the prevalence of MRSA is comparable to that of hospitals. By contrast, care facilities lack the infection control resources of hospitals.