1134. The Impact of Personal and Environmental Interventions in Methicillin Resistant Staphylococcus aureus Carriage and Infections in a Veterans Affairs Community Living Center
Session: Poster Abstract Session: MRSA/VRE Epidemiology
Friday, October 9, 2015
Room: Poster Hall
Posters
  • 1134. The Impact of Personal and Environmental Interventions in Methicillin Resistant Staphylococcus aureus Carriage and Infections in a Veterans Affairs Community Living Center.pdf (662.7 kB)
  • Background: Residence in a long-term care facility is known to be a strong risk factor for invasive Methicillin-Resistant Staphylococcus aureus (MRSA) infections. This study aims to assess the impact of MRSA prevention strategies including cultural transformation, hand hygiene and contact precautions, in addition to use of intranasal mupirocin, chlorhexidine baths and intensive environmental disinfection on MRSA colonization rates and invasive infections in a non-acute long-term care facility.

    Methods: This is a prospective cohort, quality improvement initiative carried out between November 2012 and January 2015. In November 2012, a baseline MRSA point prevalence survey was performed at the facility. Interventions on colonized residents included intranasal disinfection with 2% mupirocin and 4% chlorhexidine baths for 5 days plus environmental disinfection with daily room cleaning followed by Pulse Xenon Ultraviolet® disinfection. Prevalence surveys were repeated quarterly. Eighty-seven patients were screened at baseline and prospectively followed; there were 660 nasal swabbing events for detection of MRSA carriage and 131 decolonization interventions. Invasive MRSA and other Multidrug Resistant Organisms (MDRO) infections were determined using Centers for Disease Control definitions.

     

    Results: The prevalence of MRSA colonization in the cohort decreased from 55.2% at baseline to 11.8% after 24 months of interventions representing a 78.6% decrease in MRSA colonization (Figure 1).  There were 20 invasive MRSA infections (0.49 infections/1000 bed days of care (BDOC) in 2012 compared to 4 infections (0.11 infections/1000 BDOC) in 2014 representing a 77.6% decrease in MRSA infection rates (Table 1, Figure 2). In addition, there was a decrease in all MDRO infections during the intervention period including C. difficile infections.

     

    Table 1. Infection rates per 1000 bed days of care

     

    2012

    2014

    MRSA

    0.49

    0.11

    ESBL-E. coli

    0.86

    0

    ESBL-Klebsiella

    0.22

    0.09

    VRE

    0.43

    0.19

    CRE

    0.22

    0

    C-difficile

    5.39

    0.93

    Conclusion: A combined systematic MRSA decolonization using mupirocin and chlorhexidine in addition to environmental disinfection strategies is effective in reducing MRSA prevalence and infections in non-acute long term care settings.

    Adwait Silwal, MD1,2, Lanette Hughes, RN, BSN2, Diane Frye, RN2, Christopher Carman, RN2 and Charles De Comarmond, MD1,2, (1)Wake Forest University, Winston-Salem, NC, (2)Veterans Affairs Medical Center, Salisbury, NC

    Disclosures:

    A. Silwal, None

    L. Hughes, None

    D. Frye, None

    C. Carman, None

    C. De Comarmond, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.