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Education treatment compliance critical in household MRSA decolonization
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New study data showed the importance of education, basic hygiene and compliance with protocols for MRSA decolonization in reducing the clearance time of the bacteria in households.
“MRSA is particularly dangerous because it can colonize in others without causing an infection; and those in close contact, such as family members, are more likely to transmit MRSA to each other,” Valerie C. Cluzet, MD, an instructor of medicine in the division of infectious diseases at the Perelman School of Medicine at the University of Pennsylvania, said in a news release.
“As a result, household members could be an ongoing source of MRSA, leading to recurring infections.”
Interventions to curb MRSA
According to Cluzet and colleagues, approximately 25% of patients colonized with MRSA become acutely infected, and more than half of patients with MRSA-associated skin and soft tissue infections (SSTIs) develop recurrent infections within 1 year.
Treatment strategies vary among practitioners, and MRSA is often transmitted among household members, leading to longer infections, they wrote. Further, MRSA in the household setting may increase the risk for persistent or recurrent colonization and subsequent reinfection of patients.
Cluzet and colleagues conducted a nonmasked randomized controlled study at five academic medical centers in southeastern Pennsylvania from November 2011 through May 2013. The study comprised adults and children aged at least 6 months with acute SSTIs who tested positive for MRSA, and whose household members also agreed to participate. Patients were randomly assigned (n = 223) to one of three intervention groups: education only (n = 73); education plus decolonization (n = 76); and education plus decolonization with reminders (n = 74).
Patient education included 10 minutes of face-to-face instruction and written materials about personal hygiene, household hygiene and interrupting transmission. Decolonization consisted of patients applying 2% mupirocin ointment inside both of their nostrils twice daily for 7 days, and using a 4% chlorhexidine gluconate (CHG) body wash on the first and last day of mupirocin use.
Members of the third group received daily reminders about the procedures through phone calls or text messages.
Patients were asked to record the procedures in a journal, and after the initial 7-day period, they self-tested themselves for MRSA every 2 weeks for 6 months. Testing included swabbing their nostrils, armpits and groin creases, and in the initial skin lesion if it was still present.
Compliance equals more rapid clearance
In the modified intention-to-treat analysis, Cluzet and colleagues found “no significant difference” in the median clearance times for MRSA infection in the education-only groups (19 days; 95% CI, 15-33 days) and the two groups that underwent decolonization (23 days; 95% CI, 17-29 days).
A secondary analysis, however, on 116 index cases who had complete decolonization data and did not use decolonizing agents outside of the study showed that compliance with the study protocol led to more rapid clearance.
For the secondary analysis, Cluzet and colleagues defined patients in the education-only arm of the study as having 0% compliance. They found that index cases living in households that had 100% compliance with decolonization experienced a clearance of colonization in a median of 23 days (95% CI, 12-29 days). Clearance of colonization took 27 days (95% CI, 19-63 days) in the households with less than 100% compliance.
“We believe that our study leads to other crucial questions that deserve attention, such as the role of other parts of the household, including pets and the environment, in MRSA transmission, the importance of compliance with decolonization protocols; and the optimal timing, duration and frequency of decolonization,” Cluzet said in the release. – by Gerard Gallagher
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Louise-Marie Dembry
The medical community has long known that good hand hygiene, not sharing personal items and environmental cleaning can have an outsized impact on reducing infections. This study reiterates that patient education of these best practices, regardless of treatment prescribed, is important for reducing MRSA recurrence and household transmission.
Disclosure: Dembry reports no relevant financial disclosures.
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