High Concentration and Frequent Application of Disinfection Increase the Detection of Methicillin-Resistant Staphylococcus aureus Infections in Psychiatric Hospitals During the COVID-19 Pandemic.

ABSTRACT

The tolerance of certain multi-drug resistant bacteria to disinfectants may be promoted while the requirements of environmental disinfection have been raised in the high-risk areas of medical institutions during the COVID-19 pandemic. The current research addressed the mechanisms underlying a sharp increase in the detection of methicillin-resistant Staphylococcus aureus (MRSA) observed in a closed-management unit of elderly patients with mental disorders in 2020 as compared with the previous 4 years. We first conducted microbial detection in staff-hand and environment and a molecular epidemiology analysis, rejecting the hypothesis that the MRSA increase was due to an outbreak. Afterward, we turned to disinfectant concentration and frequency of use and analyzed the varied MRSA detection rates with different concentrations and frequencies of disinfection in 2020 and the previous 4 years. The MRSA detection rate increased with elevated concentration and frequency of disinfection, with 1,000 or 500 mg/L two times per day since January in 2020 vs. 500 mg/L 2-3 times per week in 2016-2019. When the disinfectant concentration was reduced from 1,000 to 500 mg/L, the MRSA detection decreased which indicated a modulatory role of disinfectant concentration. With a sustained frequency of disinfection in 2020, the MRSA detection rate was still higher, even after May, than that in the previous years. This suggested that the frequency of disinfection also contributed to the MRSA increase. Overall, the MRSA detection was augmented with the increase in disinfection concentration and frequency during the COVID-19 epidemic, suggesting that highly-concentrated and highly-frequent preventive long-term disinfection is not recommended without risk assessments in psychiatric hospitals.