Do rapid detection & isolation of colonised patients reduce MRSA spread? An epidemiological, economic & modelling study

耐甲氧西林金黄色葡萄球菌(MRSA)是金黄色葡萄球菌的耐药类型。它是医院获得性感染最常见的原因之一。尽管MRSA在我们的医院已经存在了40多年，但控制它的最有效的方法仍然存在争议。一些专家建议对所有高风险患者擦拭MRSA，将那些被发现携带MRSA的人隔离在单间或与其他携带者一起，并在与这些患者接触时使用特殊预防措施，如长袍和手套。这种方法的问题之一是，在微生物实验室使用通常的培养方法从拭子中检测MRSA需要2-3天。这意味着在制定控制措施方面存在拖延，这可能会降低其有效性。我们计划在皇家墨尔本医院重症监护病房测试使用隔离和特殊预防措施是否比我们目前的做法更好地防止MRSA在患者之间传播。患者在入院期间将被擦拭几次，以确定他们是否携带MRSA。我们将使用新的、快速的实验室方法，可以在几小时内从这些患者样本中检测出MRSA。这将意味着，如果患者被发现是携带者，可以及早实施隔离和特殊预防措施。我们将比较在我们没有采取任何特殊预防措施的时候有多少人感染了MRSA，而在我们采取特殊预防措施的时候有多少人感染了MRSA。我们还将进行一项经济分析，看看即使这些新的诊断方法比标准方法更昂贵，如果我们能预防患者感染，它们是否仍然值得。这项研究将帮助感染控制从业者决定，如果患者是MRSA携带者，是否应该采取特殊预防措施进行隔离。这项研究的结果将有助于更好的患者结果，更低的医院成本和更有效的资源使用。

Methicillin-resistant Staphylococcus aureus (MRSA) is the antibiotic resistant form of Golden Staph. It is one of the most common causes of hospital acquired infection. Despite the presence of MRSA for more than 40 years in our hospitals, the most efficient ways of controlling it are still debated. Some experts recommend swabbing all high risk patients for MRSA, isolating those found to be carriers it in single rooms or with other carriers and using special precautions, such as gowns and gloves, when in contact with these patients. One of the problems with this approach is that it takes 2-3 days to detect MRSA from swabs using the usual culture methods in the microbiology laboratory. This means that there are delays in instituting control measures, which may reduce their effectiveness. We plan to test whether use of isolation and special precautions is better than our current practices in preventing the spread of MRSA from patient to patient in the Royal Melbourne Hospital intensive care unit. Patients will be swabbed several times during their admission to see if they are carrying MRSA. We will use new, rapid laboratory methods that can detect MRSA within hours from these patient specimens. This will mean that if patients are found to be carriers, isolation and special precautions can be implemented early. We will compare how many people get MRSA in the time when we are not using any special precautions with how many get it in the time when we are. We are also going to undertake an economic analysis to see whether, even if these new diagnostic methods are more expensive that standard methods, they may still be worth the cost if we can prevent infections in patients. This study will help infection control practitioners to decide whether patients should be isolated with special precautions if they are MRSA carriers. The results of this study will contribute to better patient outcomes, lower hospital costs and more efficient use of resources.