[Choice of a strategy for screening for methicillin-resistant Staphylococcus aureus on admission to rehabilitation units].
OBJECTIVE
To identify a strategy of MRSA screening (methicillin-resistant Staphylococcus aureus) on admission to geriatric rehabilitation units, which would lead to acceptable efficacy and cost compared with a reference maximaliste strategy combining all six sampling sites. Method MRSA screening was conducted prospectively for 3 months in all the patients admitted to a geriatric follow-up and rehabilitation unit, using samples from the nostrils, armpits, urine scars cutaneous ulcers and sores. Six strategies were defined combing different sampling sites. Their efficacy and cost were compared with those of a maximaliste strategy combining the 6 sampling sites.


RESULTS
Combined screening of all six sites was the most effective but also the most expensive strategy. The least expensive strategy used only samples from ulcers and sores, but its efficacy was of only 45%. The strategy with the lowest loss of efficacy compared to the reference strategy combined the sampling of ulcers and sores and sampling from the nostrils: it was efficient in 91% and its cost was 2.5 fold lower than the cost of the reference strategy.


CONCLUSIONS
A preliminary, short term study established an MRSA screening strategy adapted to the specificities of a geriatric rehabilitation unit and its recruitment. The ability to define the optimal strategy for MRSA screening in a geriatric rehabilitation and follow-up unit may be an important factor in controlling the diffusion of MRSA.
Tavolacci
Marie-Pierre
MP
Unité de prévention des infections nosocomiales, Département d'épidémiologie et de santé publique, CHU-Hôpitaux de Rouen. Marie-Pierre.Tavolacci@chu-rouen.fr
Merle
Véronique
V
Dupuis
Michel
M
Van Doren
Caroline
C
Josset
Valérie
V
Houdent
Gérard
G
Lemeland
Jean-François
JF
Czernichow
Pierre
P
D000368:Aged; D003362:Cost-Benefit Analysis; D005853:Geriatrics; D006801:Humans; D008403:Mass Screening; D016106:Methicillin Resistance; D010343:Patient Admission; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012883:Skin Ulcer / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity*