Novel program decreased MRSA infections by 65% in long-term care

PHILADELPHIA — Active MRSA surveillance along with targeted decolonization significantly decreased the rate of clinical MRSA infection among residents in long-term care facilities and did not require patient isolation, researchers here reported.

“Long-term care facilities present a unique challenge for infection prevention and control,” Lance Peterson, MD, of the NorthShore University Health System in Evanston, Ill., and the Pritzker School of Medicine at the University of Chicago, said during his presentation. “Many residents are vulnerable older adults with many opportunities for direct interaction among residents, visitors and health care personnel. An important goal is to find effective ways of minimizing the risk of health care-associated infections while maintaining the desired interactive lifestyle for these patients.”

Peterson and colleagues performed a prospective, cluster-randomized trial in three long-term care facilities over 2 years to reduce MRSA infection. In the first year, nursing units were stratified by type of care and were randomly assigned to intervention or control. The intervention included nasal decolonization of all residents with nasal mupirocin twice daily for 5 days, and a chlorhexidine bath. The intervention was repeated at 30 days. In the second year, all units were converted to the intervention.

The units also received annual instruction on hand hygiene and enhanced cleaning with bleach. In addition, all new admissions were screened and patients who were positive were decolonized once, but not isolated. The researchers evaluated changes in the MRSA clinical infection rate for the 2 years, compared with the baseline rate of 0.120 infections per 1,000 patient-days.

In year 1, there were 23 MRSA infections in 294,165 patient-days, for a rate of 0.078 infections per 1,000 patient-days (P=0.09). In year 2, there were 12 infections in 287,847 patient-days, for a rate of 0.042 infections per 1,000 patient-days (P<.001). Peterson said this program was minimally-invasive and did not interfere with socialization or activities of daily living among the residents.

“There was a 65% reduction in MRSA clinical infection by year 2, when all units were included in the program, and the program did not require patient isolation,” Peterson said. — by Emily Shafer

For more information:

Smith B. Abstract 637. Presented at IDWeek 2014; Oct. 8-12; Philadelphia.

Disclosure: Peterson receives research grant funding from Cepheid.