MRSA-Hygiene in der stationären Rehabilitation am Beispiel der onkologischen Rehabilitation - Ein Positionspapier

Abstract

Infections and colonizations with methicillin resistant staphylococcus aureus (MRSA) are an increasing problem in German hospitals because they spread there more and more. In homes without predominant nursing care and without hospital-like medical care of the inhabitants, genotypically identical MRSA-strains are rarely found in room neighbours up to now. The recommendations on prevention and control of MRSA published by the Robert Koch-Institut (RKI) therefore are partially discrepant for these two fields. The setting in rehabilitation medical centres, from hygienic points of view, is in many respects similar to a medical practice or a home with predominantly independent inhabitants rather than to a hospital for patients with acute diseases. For an effective and humane stationary rehabilitation of patients with MRSA colonisation it would be desirable to define conditions under which the strict isolation-hygiene prescribed for acute hospitals could be deviated from, following e. g., the RKI recommendations for homes instead. With the input of a summary of the clinical relevance of MRSA and a comparison of both partly identical, partially however very different RKI-recommendations on prevention and control of MRSA the present article seeks to characterize the hygienic setting in (particularly oncological) stationary rehabilitation under the above aspects. A series of recommendations on MRSA hygiene in stationary rehabilitation follows, which depending on the risk profile involved is based partially on the RKI guidelines for hospitals, partially however, on the guidelines for homes. The recommendations have a preliminary character without claiming completeness or the rank of a guideline. They are intended to focus on a problem which arises more and more frequently also in rehabilitation centers. They can, in the individual case, provide a useful help for the practice in stationary rehabilitation particularly as there are no publications on the subject of MRSA hygiene so far which meet the circumstances in stationary rehabilitation in a different manner.