[A study on the transmission of MRSA among the family members including clients of visiting nurse and related infection control].
OBJECTIVE
The purpose of the study was to clarify MRSA (methicillin-resistant Staphylococcus aureus) transmission among clients, receiving nursing care from visiting nurse stations, and family members, as well as to determine MRSA positive rates of visiting nurses themselves and their handwashing habits.


METHODS
The subjects were 131 clients who had utilized 32 visiting nurse stations, and had tested MRSA positive in our previous study performed 2-5 months earlier. The presence of MRSA in the nasal passages was investigated in 15 of the 131 MRSA positive clients and the 24 family members who had agreed to cooperate. Antibiotic sensitivity tests of the involved strains of MRSA were conducted using 14 antibiotics to allow antibiotic resistance patterns to be compared. 148 nurses who worked at 18 visiting nurse stations were also screened for MRSA in their nasal passages. In addition, a self-administered questionnaire was filled in concerning their handwashing habits.


RESULTS
Out of 15 clients from whom MRSA was isolated in the previous study, 9 became MRSA positive (60.0%), and this was the case for 6 family members, living with 4 of them. The antibiotic resistance patterns coincided among the family members of 3 families, suggesting MRSA transmission among the client and his/her family member(s). MRSA transmission was shown not to be influenced by the ADL (activities of daily living) of a client nor by the content or time of the care provided by family member(s). As for visiting nurses, MRSA was isolated from 1 out of 148 (detection rate: 0.7%). The practice rate for handwashing was 91.2% after visiting as compared to 22.1% before visiting, and 93.4% after care as compared to 37.5% before care; the differences were significant (P < 0.001). The most frequently used handwashing procedures included handwashing with soap, povidone iodine and other disinfectants. The practice rate were 94.9% in visiting nurse stations and 91.2% in clients' homes. There was no significant difference between the procedures in these settings.


CONCLUSIONS
Family members who are living with MRSA carriers are in danger of MRSA transmission irrespective of the content of the care, suggesting the need to prevent spread into compromised hosts or the community. On the other hand, visiting nurses are seldom infected with MRSA, and transmission of MRSA from nurses to clients is a rare event. This study showed, however, a low rate of handwashing before client contact. The possibility of cross infection from the hands of visiting nurses to their clients therefore needs further study.
Matsumoto
K
K
Department of Family Nursing, Graduate School of Medicine, University of Tokyo.
Hohashi
N
N
Sugishita
C
C
D000368:Aged; D000369:Aged, 80 and over; D003152:Community Health Nursing; D005190:Family; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D017757:Infectious Disease Transmission, Professional-to-Patient; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000517:prevention & control / Q000635:transmission*