A purpose built MRSA cohort unit

The control of hospital-acquired infection, in particular methicillin-resis tant Staphylococcus aureus (MRSA) remains a challenge. Our hospital has est ablished a purpose built Ii-bed cohort unit with on-site rehabilitation for care of patients colonized with MRSA, in an attempt to improve their quali ty of care. Prior to the opening of this unit a number of concerns were voi ced and the aim of this study was to address these. First, to establish if patient cohorting reduces the likelihood of successful decolonization, seco nd, to evaluate the risk of staff colonization, and finally to see if succe ssful environmental control of MRSA is possible. A patient database was established detailing patient demographics, infectio n rates, eradication and reacquisition rates. Staff screening aias performe d weekly, at the start of a period of duty Sixty environmental sites were s creened before unit opening, at 48 h, six weeks and at six months. There were 88 admissions in the first six months; 62 patients were colonize d with MRSA, and 26 patients (10 surgical, 16 medical) had MRSA infections. Twenty-three of 88 patients (26%) were successfully decolonized, which com pares favourably with an eradication rate of 20% for the rest of the hospit al. Twenty staff members participated in weekly screening. Five staff membe rs colonized with MRSA were detected and all were successfully decolonized. Environmental control was achieved with a combination of a daily detergent clean and a once weekly clean with phenolic disinfectant. Our preliminary data suggest that, despite cohorting patients colonized wit h MRSA, with proper education and supervised cleaning protocols, it is poss ible to control environmental MRSA load, successfully decolonize patients a nd limit the risk of staff colonization. (C) 2000 The Hospital infection So ciety.