European survey of management of patients with multidrug-resistant organisms in rehabilitation facilities

BACKGROUND: Rehabilitation facilities have among the highest prevalence of multidrug-resistant organism (MDRO) colonization of any inpatient population. There is no formal consensus on how patients with MDROs should be managed in the rehabilitation setting. AIM: The aim of this study was to assess how rehabilitation hospitals throughout Europe manage patients with MDROs, and the impact of MDRO carriage on outcomes. DESIGN: Cross-sectional study. SETTING: Online questionnaire distributed to European rehabilitation facilities. POPULATION: European rehabilitation facilities. METHODS: A Survey Monkey (R) questionnaire was designed and circulated to rehabilitation hospitals via the European Union of Medical Specialists, Physical and Rehabilitation Medicine Section. RESULTS: Fifty-four responses were received of which 45 were suitable for analysis. Six out of 26 (23%) countries included in the study reported at least one rehabilitation facility with an estimated MDRO prevalence rate of 31% or higher. Screening of all patients on admission was always carried out in 33% (15 of 45) of facilities. Twenty-five of the 45 facilities (69%), aim to isolate, or cohort patients who have MDROs. Patients with MDROs wait longer for admission (36%, 16 of 45) and in the case of five hospitals admission is refused. Fifty-one percent (23 of 45) of facilities reported that colonization with an MDRO severely or moderately limits rehabilitation outcome. CONCLUSIONS: Our research shows that many of the challenges posed by MDROs are common to facilities throughout Europe. We strongly recommend that all patients are screened for MDROs on admission. We stress that any negative impact of a patients MDRO status on their rehabilitation outcome must be minimized. CLINICAL REHABILITATION IMPACT: Specific guidance on the management of rehabilitation patients with MDROs, would allow them to partake in a full rehabilitation program, while limiting the spread of MDROs.