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An Integrated Approach to Methicillin-Resistant Staphylococcus aureus Control in a Rural, Regional-Referral Healthcare Setting

Published online by Cambridge University Press:  02 January 2015

William A. Bowler ,
Jeanine Bresnahan ,
Ann Bradfish  and
Christine Fernandez
William A. Bowler*
Affiliation:
Aspirus Wausau Hospital, Wausau, Wisconsin
Jeanine Bresnahan
Affiliation:
Aspirus Wausau Hospital, Wausau, Wisconsin
Ann Bradfish
Affiliation:
Aspirus Wausau Hospital, Wausau, Wisconsin
Christine Fernandez
Affiliation:
Aspirus Wausau Hospital, Wausau, Wisconsin
*
Aspirus Wausau Hospital, 333 Pine Ridge Blvd., Wausau, WI 54401 (iddoc@dwave.net)
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Extract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 3 , March 2010 , pp. 269 - 275
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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