Epidemiologic and Molecular Investigation of a MRSA Outbreak Caused by a Contaminated Bathtub for Carbon Dioxide Hydrotherapy and Review of the Literature.

METHODS: We conducted an outbreak investigation and performed a molecular typing of the outbreak strains with pulsed-field gel electrophoresis (PFGE). In addition, we reviewed PubMed and the Outbreak Database for MRSA outbreaks related to hydrotherapy or other bathing activities. RESULTS: Four patients acquired nosocomial MRSA during the 4-week outbreak period. Environmental sampling revealed the presence of MRSA in the bathtub used for hydrotherapy. The environmental and the patients' isolates showed an indistinguishable restriction pattern in the PFGE. Subsequent discontinuation of bathing stopped the outbreak. The literature search found 9 MRSA outbreak reports related to bathing activities or hydrotherapy. CONCLUSION: The epidemiologic outbreak investigation together with the molecular findings suggests monoclonal spread of MRSA due to surface contamination of the bathtub. After enhancing the disinfection and cleaning process accompanied by staff training with respect to hand hygiene, no further cases occurred. Standardized and best practice cleaning and disinfection protocols are crucial, especially in critical facilities such as hydrotherapy units. Regular environmental sampling is helpful to monitor these processes and to detect potential contamination.

Hannover model for the implementation of physical and rehabilitation medicine teaching in undergraduate medical training.

As any patient may require rehabilitation and physical therapies, all physicians need to acquire at least a basic knowledge of Physical and Rehabilitation Medicine (PRM). In 2005 PRM teaching was implemented in all phases of the curriculum for medical students in Germany. The curriculum includes, among others, the following topics: principles of rehabilitation; the model of the International Classification of Functioning, Disability and Health (ICF); principles and effects of physiotherapy and occupational therapy; indications and contraindications for PRM interventions. Teaching of PRM topics is implemented from the first week in all phases of the curriculum, as: (i) lectures in the module "Introduction to Medicine (Propaedeuticum)"; (ii) a cross-sectional course entitled "Rehabilitation, Physical Medicine and Naturopathic Treatment (RPMN)"; (iii) single lectures on PRM in other fields; (iv) elective mandatory courses on the social model of rehabilitation, balneology, and others; and (v) the option to choose PRM as a subject for practical training. All modules are evaluated regularly by the students. Global ratings of the module "Propaedeuticum" were good, and of the cross-sectional course "RPMN" very good. The advanced part of the practical training was rated highly by the students. In conclusion, the implementation of teaching of PRM and other rehabilitation topics in undergraduate medical education is a successful concept that fulfils the criteria for education in medical school set out by the American Association of Academic Physiatrists.

Long term results of compartment syndrome of the lower limb in polytraumatised patients.

Acute compartment syndrome represents a severe complication after trauma of the lower extremity. To date, there is limited knowledge about the outcome of compartment syndrome of the lower limb in patients with multiple injuries. We hypothesised that multiple injuries worsen the long term results of compartment syndrome of the lower leg. Patients who underwent fasciotomy for established compartment syndrome of the lower leg from 1999 to 2004 in our level 1 trauma centre were included. Demographic data, additional injuries (Injury Severity Score) and method of treatment were analysed. Outcome assessments included clinical examination and isokinetic strength testing of plantar flexion and dorsal extension at two different angular velocities (60 degrees /s; 120 degrees /s). The mean age was 38.0+/-4.4 years at the time of injury; males were affected twice as often as females. The mean ISS of patients with multiple injuries was 20.2+/-2.3 points. The time between admission and surgical treatment of compartment syndrome was extended in patients with multiple injuries (38.6+/-13.8h versus 13.2+/-3.8h; p=0.04). At follow-up, 15.4% of all patients complained of pain at rest and 26.9% reported pain on exertion. A significant reduction of torque and work was found in the dorsal extensors on the injured side (p<0.05). Polytraumatised patients did not show extended weakness compared to those with isolated injuries. No difference was seen between the two groups regarding pain and function. Polytraumatised patients did not suffer from worse long term effects regarding sensory or motor deficits. Associated injuries did not seem to influence the outcome of the compartment syndrome.