Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home.
BACKGROUND
Long-term health care facilities have been recognized as reservoirs of multiresistant bacterial strains, especially methicillin-resistant Staphylococcus aureus (MRSA). Efforts to control MRSA in this setting usually have been only partially effective. We describe herein the eradication of epidemic MRSA from a Finnish health care center ward and affiliated nursing home.


METHODS
The methods to control MRSA included (1) contact isolation precautions, (2) screening for asymptomatic carriage, (3) eradication of carriage, and (4) education of staff on hygienic measures. The first 6 patients with MRSA-positive findings were referred without delay to the Infectious Diseases Unit of the adjacent university hospital for eradication treatment. Later, an isolation unit of 6 rooms was founded in the health care center, where the MRSA-colonized patients were nursed as a separate cohort until they, in succession, were referred to the Infectious Diseases Unit for decolonization.


RESULTS
From May 20 through August 17, 1993, the epidemic MRSA strain was isolated from 8 long-term patients on the 40-bed ward of the health care center, 4 of the 59 residents of the nursing home, and 1 member of the staff. Eradication of carriage was successful in all except 1 patient with dementia, who was nursed in contact isolation in the health care center until his death 21 months later.


CONCLUSIONS
It is possible to eradicate MRSA from a long-term health care facility even after 13 cases by applying strict control measures. Our experience may be valuable in the future decision-making process for control of new and more challenging multiresistant bacteria, eg, vancomycin-resistant strains of MRSA.
Kotilainen
P
P
Department of Medicine, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland. pirkko.kotilainen@utu.fi
Routamaa
M
M
Peltonen
R
R
Evesti
P
P
Eerola
E
E
Salmenlinna
S
S
Vuopio-Varkila
J
J
Rossi
T
T
D000368:Aged; D015331:Cohort Studies; D004196:Disease Outbreaks; D006707:Homes for the Aged; D006801:Humans; D008712:Methicillin / Q000627:therapeutic use*; D016106:Methicillin Resistance; D009735:Nursing Homes; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects*
D008712:Methicillin