title: A purpose built MRSA cohort unit.
abstract: The control of hospital-acquired infection, in particular methicillin-resistant Staphylococcus aureus (MRSA) remains a challenge. Our hospital has established a purpose built 11-bed cohort unit with on-site rehabilitation for care of patients colonized with MRSA, in an attempt to improve their quality of care. Prior to the opening of this unit a number of concerns were voiced and the aim of this study was to address these. First, to establish if patient cohorting reduces the likelihood of successful decolonization, second, to evaluate the risk of staff colonization, and finally to see if successful environmental control of MRSA is possible.A patient database was established detailing patient demographics, infection rates, eradication and reacquisition rates. Staff screening was performed weekly, at the start of a period of duty. Sixty environmental sites were screened before unit opening, at 48h, six weeks and at six months. There were 88 admissions in the first six months; 62 patients were colonized with MRSA, and 26 patients (10 surgical, 16 medical) had MRSA infections. Twenty-three of 88 patients (26%) were successfully decolonized, which compares favourably with an eradication rate of 20% for the rest of the hospital. Twenty staff members participated in weekly screening. Five staff members colonized with MRSA were detected and all were successfully decolonized. Environmental control was achieved with a combination of a daily detergent clean and a once weekly clean with phenolic disinfectant. Our preliminary data suggest that, despite cohorting patients colonized with MRSA, with proper education and supervised cleaning protocols, it is possible to control environmental MRSA load, successfully decolonize patients and limit the risk of staff colonization.
authors.affiliation: Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. f.fitzpatrick@st-vincents.ie
authors.forename: F
authors.initials: F
authors.lastname: Fitzpatrick
authors.forename: O M
authors.initials: OM
authors.lastname: Murphy
authors.forename: A
authors.initials: A
authors.lastname: Brady
authors.forename: S
authors.initials: S
authors.lastname: Prout
authors.forename: L E
authors.initials: LE
authors.lastname: Fenelon
mesh_terms: D002353:Carrier State / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control* / Q000534:rehabilitation* / Q000635:transmission; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D007318:Inservice Training; D007494:Ireland; D008297:Male; D008403:Mass Screening / Q000379:methods; D016106:Methicillin Resistance; D009741:Nursing Staff, Hospital / Q000193:education; D010356:Patient Isolation / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors; D012621:Seasons; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control* / Q000534:rehabilitation* / Q000635:transmission; D013211:Staphylococcus aureus