Program Schedule

637
Control of Methicillin-Resistant Staphylococcus aureus (MRSA) in Long Term Care is Possible While Maintaining Patient Socialization without Isolation

Session: Oral Abstract Session: Epidemiology of MRSA and Impact of Control Interventions
Friday, October 10, 2014: 11:00 AM
Room: The Pennsylvania Convention Center: 111-AB
Background: To reduce MRSA clinical disease in Long Term Care Facilities (LTCFs), we evaluated a novel program that was minimally invasive and did not interfere with activities of daily living (ADL) or socialization of patient-residents. We hypothesized that reducing MRSA disease without contact precautions is possible and that demonstration of this success could lead to an ongoing relationship between acute care hospitals and LTCFs.

Methods: A prospective, cluster-randomized trial was performed in 3 LTCFs over 2 years to reduce MRSA colonization with the goal of lowering MRSA clinical infection. During Year 1 nursing units at the 3 LTCFs were stratified by type of care and randomized to either intervention or control units. In Year 2 all nursing units were converted to intervention that consisted of nasal decolonization of all patient-residents using nasal mupirocin twice daily for 5 days and a chlorhexidine bath. The intervention was repeated at 30 days (i.e., 2 decolonization/ bathing cycles). All units received annual instruction on the importance of hand hygiene as well as enhanced cleaning with bleach wiping of all flat surfaces every 4 months.  Concurrently with the start of decolonization and continuing thereafter, all new admissions were screened on site using real-time PCR (Cepheid GeneXpert®) and those positive were decolonized (once) but not isolated.  Changes in the rate of MRSA clinical infection for the 2 years of study were compared to the Baseline MRSA clinical infection rate.

Results: The overall rate of MRSA infections significantly decreased between the Baseline and Year 2 (Table). A significant reduction of MRSA infections was also observed at each of the 3 individual LTCFs (p<0.03).

Table. Clinical MRSA Infections during the three study periods (PD = Patient Days). 

Period

MRSA Infections

PD

Rate/1000 PD

p Value

Baseline

44

365,809

0.120

ref

Year 1

23

294,165

0.078

=0.09

Year 2

12

287,847

0.042

<0.001

Conclusion: Active MRSA surveillance with targeted decolonization resulted in a significant decrease in the rate of clinical MRSA infection among LTCF residents without limiting socialization or ADL.  Furthermore, developing a formal, contracted relationship between our acute care hospital system and the LTCFs has lead to an ongoing infection prevention interaction beyond control of MRSA.

Becky Smith, MD1, Susan Boehm, RN BSN2, Jennifer Beaumont, MS3, Ari Robicsek, MD2, Parul Patel, BS MT(ASCP), CCRP2, Donna Schora, MT(ASCP)2, Deborah Burdsall, RN-BC, CIC4, Kari Peterson, BA2, Maureen Fausone, BA5 and Lance Peterson, MD2,6, (1)Infectious Diseases, Pritzker School of Medicine, University of Chicago, Chicago, IL, (2)NorthShore University HealthSystem, Evanston, IL, (3)Department of Medical Social Sciences, Northwestern University, Chicago, IL, (4)Infection Control, Lutheran Home/Lutheran Life Communities, Arlington Heights, IL, (5)Research, NorthShore University HealthSystem, Evanston, IL, (6)Pritzker School of Medicine, University of Chicago, Chicago, IL

Disclosures:

B. Smith, None

S. Boehm, None

J. Beaumont, None

A. Robicsek, None

P. Patel, None

D. Schora, None

D. Burdsall, None

K. Peterson, None

M. Fausone, None

L. Peterson, Cepheid: Investigator, Research grant

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

Sponsoring Societies:

© 2014, idweek.org. All Rights Reserved.

Follow IDWeek