title: [Multidrug-Resistant Organisms (MDRO) in Rehabilitation Clinics in the Rhine-Main District, Germany, 2014: Risk Analysis and Hygiene Procedures].
abstract: BACKGROUND
  Many regional German MDRO-networks aim to improve the medical rehabilitation of patients with methicillin-resistant Staphylococcus aureus (MRSA) and other multidrug-resistant pathogens. In 2014, the German Commission for Hospital Hygiene and Infection Control (KRINKO) released revised recommendations for the care of patients with MRSA. In particular, for rehabilitation facilities, these recommendations stipulated a medical risk analysis to establish necessary hygiene measures, and provide specific recommendations.
  
  
  METHODS
  Based on a large investigation carried out in 21 rehabilitation facilities covering different medical specialties, medical risk analyses according to KRINKO were performed, and the findings evaluated separately for orthopedic, cardiologic, oncologic, neurologic, or geriatric facilities, as well as for all institutions taken together.
  
  
  RESULTS
  The overall colonization pressure, i. e. the point prevalence of MRSA and extended spectrum beta-lactamase-producing gram-negative pathogens (ESBL) among hospitalized rehabilitation patients was found to be 0.7% and 7.7%, respectively. Impairment of the intact skin (an established risk factor for persisting MRSA colonization and MRSA infection) was found in 7% of the patients, impaired mobility requiring enhanced level of care in 4.1%, and mental confusion and/or incontinence (potentially impairing the application of hygiene measures) in 11% of patients. Compared to the total study population, there was an increase in all risk factors in geriatric and neurologic rehabilitation patients: skin barrier breaches (in neurologic and in geriatric patients: 18.3 and 19.2%, respectively), impaired mobility (32.7 and 37.0%, respectively), and mental confusion/incontinence (24.5 and 28.0%, respectively). In addition, geriatric patients demonstrated an increased overall prevalence of multidrug-resistant organisms (MRSA: 9.4%; ESBL: 22.7%).
  
  
  CONCLUSIONS
  Risk analysis according to KRINKO showed that in rehabilitation facilities with internal medicine or orthopedics specialties, there was a comparably lower risk for transmission, colonization, and/or infection with multidrug-resistant pathogens, as against institutions with neurologic or geriatric specialty. It appears that in the first type of rehabilitation facilities, consistently carried out basic hygiene measures are sufficient while in neurologic or geriatric rehabilitation hospitals, these measures should be supplemented with additional hygiene measures based on medical risk analysis. Furthermore, for infection control purposes in rehabilitation facilities, patient isolation will be rarely necessary or appropriate. These analyses suggest that in the future, rehabilitation programs for MRSA/ESBL-colonized patients will be more successful.
authors.affiliation: MRE-Netz Rhein-Main.
authors.forename: U
authors.initials: U
authors.lastname: Heudorf
authors.affiliation: MRE-Netz Rhein-Main.
authors.forename: D
authors.initials: D
authors.lastname: Färber
authors.affiliation: MRE-Netz Rhein-Main.
authors.forename: D
authors.initials: D
authors.lastname: Mischler
authors.affiliation: MRE-Netz Rhein-Main.
authors.forename: M
authors.initials: M
authors.lastname: Schade
authors.affiliation: Institut für Medizinische Diagnostik GmbH, Zentrum für Hygiene und Infektionsprävention, Ingelheim.
authors.forename: C
authors.initials: C
authors.lastname: Zinn
authors.affiliation: Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar und MRSAar Netz.
authors.forename: D
authors.initials: D
authors.lastname: Nillius
authors.affiliation: Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar und MRSAar Netz.
authors.forename: M
authors.initials: M
authors.lastname: Herrmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data*; D004864:Equipment and Supplies / Q000382:microbiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006920:Hygiene; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D055815:Young Adult