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Eradication of Methicillin-Resistant Staphylococcus aureus From a Health Center Ward and Associated Nursing Home
Pirkko Kotilainen, MD, PhD;
Marianne Routamaa, RN;
Reijo Peltonen, MD, PhD;
Pirjo Evesti, MD;
Erkki Eerola, MD, PhD;
Saara Salmenlinna, MSc;
Jaana Vuopio-Varkila, MD, PhD;
Tuire Rossi, MD
Arch Intern Med. 2001;161:859-863.
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.
From the Departments of Medicine (Drs Kotilainen, Peltonen, and Rossi)
and Surgery (Ms Routamaa and Dr Evesti), Turku University Central Hospital,
the Department of Medical Microbiology, Turku University (Dr Eerola), and
the Antimicrobial Research Laboratory, National Public Health Institute (Dr
Kotilainen), Turku, Finland; the Mynamaki Health Center, Mynamaki, Finland
(Dr Evesti); and the Department of Bacteriology, National Public Health Institute,
Helsinki, Finland (Ms Salmenlinna and Dr Vuopio-Varkila).
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