A Liberal Isolation Policy and MRSA Surveillance

In a presentation at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland. from June 29 through July 2, 2011, researchers from the hygiene team of the Rehabilitation Centre Inkendaal in Vlezenbeek, Belgium reported that infection control strategies taken for MRSA spread in their rehabilitation center did not lead to a high incidence density of MRSA clinical samples. The researchers say that continuous focus is given to information about standard and specific precautions and training sessions for all healthcare workers and that no single room isolation is done for MRSA-positive patients. They add that chemical decolonization is performed on selective patients.

Monsieur and Wauters explain that in their hospital with 178 beds, the core business is multidisciplinary rehabilitation, and that close contacts between staff, patients and their environment are inherent in this process. They say that isolation in single rooms in case of MRSA is not advisable in the purpose of social reintegration. They say that iolation is difficult because of long stay and a limited number of single rooms. Before changing the MRSA isolation policy the hygiene team started their infection control program in 2007 with focus on MRSA.

In every admission an MRSA screening of the nose is taken. Clinical samples are also taken from exsudative wounds, sputum and urine on admission as well as during hospitalisation. Strategies to prevent patient-to-patient transmission exist from standard precautions with hand hygiene for all residents, waring gloves, gown and eye protection glasses for contact with blood and body fluids. All healthcare workers are informed and trained by the hygiene team during information sessions. In case of single MRSA colonization in the nose, chemical decolonization is done. Microbiological data from screenings and clinical samples are collected. Differentiation between colonization and infection is made.

The nosocomial MRSA incidence density in clinical samples in 2008, 2009, 2010 was respectively 0.28; 0.15; 0.15. In 2008 only six cases out of 15 were nosocomial infection, in 2009 1 out of 6; in 2010 6 out of 8.

Reference: Monsieur I and Wauters M. MRSA surveillance in a rehabilitation centre with liberal isolation policy. Presentation from International Conference on Prevention & Infection Control (ICPIC 2011). BMC Proceedings 2011, 5(Suppl 6):P180doi:10.1186/1753-6561-5-S6-P180