Methicillin-resistant Staphylococcus aureus (MRSA) in rehabilitation and chronic-care-facilities: what is the best strategy?

Patrica Minary-Dohen,Pascale Bailly,Xavier Bertrand,Daniel Talon

doi:10.1186/1471-2318-3-5

Patrica Minary-Dohen, Pascale Bailly + Show 2 more

Open Access

https://doi.org/10.1186/1471-2318-3-5

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Abstract

BackgroundThe risk associated with methicillin-resistant Staphylococcus aureus (MRSA) has been decreasing for several years in intensive care departments, but is now increasing in rehabilitation and chronic-care-facilities (R-CCF). The aim of this study was to use published data and our own experience to discuss the roles of screening for MRSA carriers, the type of isolation to be implemented and the efficiency of chemical decolonization.DiscussionScreening identifies over 90% of patients colonised with MRSA upon admission to R-CCF versus only 50% for intensive care units. Only totally dependent patients acquire MRSA. Thus, strict geographical isolation, as opposed to "social reinsertion", is clearly of no value. However, this should not lead to the abandoning of isolation, which remains essential during the administration of care. The use of chemicals to decolonize the nose and healthy skin appeared to be of some value and the application of this procedure could make technical isolation unnecessary in a non-negligible proportion of cases.SummaryGiven the increase in morbidity associated with MRSA observed in numerous hospitals, the emergence of a community-acquired disease associated with these strains and the evolution of glycopeptide-resistant strains, the voluntary application of a strategy combining screening, technical isolation and chemical decolonization in R-CCF appears to be an urgent matter of priority.

Highlights

The risk associated with methicillin-resistant Staphylococcus aureus (MRSA) has been decreasing for several years in intensive care departments, but is increasing in rehabilitation and chronic-care-facilities (R-CCF)
Summary: Given the increase in morbidity associated with MRSA observed in numerous hospitals, the emergence of a community-acquired disease associated with these strains and the evolution of glycopeptide-resistant strains, the voluntary application of a strategy combining screening, technical isolation and chemical decolonization in R-CCF appears to be an urgent matter of priority
The treatment of nasal MRSA carriage is recommended if the nose is the only site colonised or if the other colonised sites are accessible to treatment; an antiseptic wash should be used in such cases [10]

Summary

Introduction

The risk associated with methicillin-resistant Staphylococcus aureus (MRSA) has been decreasing for several years in intensive care departments, but is increasing in rehabilitation and chronic-care-facilities (R-CCF). The procedures mentionned in italic are proposed by the CTIN as complementary measures and are implemented according epidemiological situation of the hospital and/or the ward have implemented prevention measures These measures have proved to be effective, as shown by stabilisation of the number of MRSA infections in hospitals in which the risk was increasing or by an even greater reduction in the number of MRSA infections in these units than in other types of unit in which the risk was tending to decrease [68]. Concerns were encountered when implementing these measures in this kind of departments because the mean length of hospitalisation is much longer, the ratio of patients to medical staff ratio is higher and the patients need to take part in physical and social activities, which are considered to be incompatible with isolation precautions [10,11,12,13]

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