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An integrated approach to methicillin-resistant Staphylococcus aureus control in a rural, regional-referral healthcare setting.

Abstract：

OBJECTIVE:To curtail the prevalence and cross-transmission of methicillin-resistant Staphylococcus aureus (MRSA) in a rural healthcare setting. DESIGN:Before-after, quasi-experimental quality improvement study. SETTING:A regional-referral hospital, 5 affiliated nursing homes, and an outpatient MRSA clinic. INTERVENTIONS:Residents of the 5 nursing homes were screened for MRSA at baseline and 1 year later. Active surveillance cultures were performed on subsequently admitted nursing home residents, "high-risk" patients admitted to the hospital, and household contacts of clinic patients. The decolonization regimen consisted of systemic therapy with minocycline and rifampin and topical therapy with nasal mupirocin ointment and 5% tea tree oil body wash. Three separate samples for cultures to document clearance of MRSA colonization were obtained at 1-week intervals 1 month after the completion of decolonization therapy. Samples for follow-up cultures were obtained at month 6 and month 12 after the completion of decolonization therapy. RESULTS:After intervention and follow-up for 12 months or more, the prevalence of MRSA carriage at the nursing homes decreased by 67% (P < .001), and 120 (82%) of 147 nursing home residents and 111 (89%) of 125 clinic patients remained culture-negative for MRSA. Twenty-three (24%) of 95 new clinic patients had at least 1 MRSA-positive contact. Mupirocin resistance did not develop. In the hospital, the incidence rate of nosocomial MRSA infection decreased from 0.64 infections per 1,000 patient-days before the interventions to 0.40 infections per 1,000 patient-days 1 year after the interventions and to 0.32 infections per 1,000 patient-days 2 years after the intervention (P < .01). CONCLUSIONS:Use of active surveillance cultures and decolonization therapy was effective in decreasing the prevalence of asymptomatic carriage, the incidence of nosocomial infection, and the overall prevalence of MRSA in our rural healthcare setting.

journal_name

Infect Control Hosp Epidemiol

journal_title

Infection control and hospital epidemiology

authors

Bowler WA,Bresnahan J,Bradfish A,Fernandez C

doi

10.1086/650445

subject

Has Abstract

pub_date

2010-03-01 00:00:00

pages

269-75

issue

eissn

0899-823X

issn

1559-6834

journal_volume

pub_type

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An integrated approach to methicillin-resistant Staphylococcus aureus control in a rural, regional-referral healthcare setting.